Aminoglycoside monitoring program

Abstract

An aminoglycoside monitoring program (AMP) using pharmacokinetic variables is described. The AMP was established in one patient-care pharmacy that served 69 medical/surgical beds. The pharmacists received a two-hr instructional course designed to refamiliarize them with basic pharmacokinetic concepts and the practical application of these concepts. A form was developed to assist monitoring. From data recorded on the form, pharmacists calculate ideal body weight, creatinine clearance, predicted rate of elimination, half-life, volume of distribution, serum peak (Cmax) and serum trough (Cmin) concentrations, dosing interval, and maintenance dose. Aminoglycoside therapy is evaluated and assessed daily based on whether or not: (1) predicted Cmax or Cmin concentrations are above the recommended concentrations, (2) predicted Cmax or Cmin are below the recommended concentrations, or (3) actual serum concentrations are necessary before a dose assessment is made. The pharmacist notifies the physician and records any recommendations concerning aminoglycoside therapy. Within the first year of the program, 304 patients were placed on tobramycin or gentamicin therapy; for 21% of them, dosage recommendations were made to the physician. The AMP provides the hospital pharmacist with an opportunity to use aminoglycoside pharmacokinetic theory in everyday practice.