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Comparison of gentamicin dose estimates derived from manual calculations, the Australian ‘Therapeutic Guidelines: Antibiotic’ nomogram and the SeBA‐GEN and DoseCalc software programs
Author(s) -
Mohan Mitali,
Batty Kevin T.,
Cooper Jennifer A.,
WojnarHorton Richard E.,
Ilett Kenneth F.
Publication year - 2004
Publication title -
british journal of clinical pharmacology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.216
H-Index - 146
eISSN - 1365-2125
pISSN - 0306-5251
DOI - 10.1111/j.1365-2125.2004.02201.x
Subject(s) - nomogram , gentamicin , medicine , antibiotics , therapeutic drug monitoring , renal function , urology , surgery , confidence interval , pharmacokinetics , biology , microbiology and biotechnology
Aim To compare gentamicin dose estimates from four predictive methods. Methods A retrospective study was conducted, comprising patients at Fremantle Hospital who received gentamicin therapy and had at least one gentamicin serum concentration reported. A manual calculation method, the Australian ‘Therapeutic Guidelines: Antibiotic’ (TGA) nomogram and the SeBA‐GEN and DoseCalc software packages were compared. SeBA‐GEN dose estimates were regarded as the reference standard. Results There were 64 males and 30 females with mean age of 58 ± 16 years. In patients with moderate renal impairment (CL Cr = 30–60 ml min −1 ; n = 21), mean dose estimates using DoseCalc and the manual calculation method were comparable to SeBA‐GEN but the mean TGA nomogram dose (230 mg; 95% confidence interval 179, 281) was significantly lower than SeBA‐GEN (286 mg; 261, 311; P = 0.002; one‐way RM anova ). In patients with mild renal impairment (CL Cr = 60–90 ml min −1 ; n = 48), DoseCalc (392 mg; 367, 427) was comparable to SeBA‐GEN (377 mg; 362, 392). Although the manual method (341 mg; 306, 376; P = 0.007) and the TGA nomogram (335 mg; 302, 368; P < 0.001) estimates were significantly lower than SeBA‐GEN, the practical difference was modest. Conclusions SeBA‐GEN and DoseCalc are generally comparable for estimation of gentamicin doses in patients with renal impairment. The ‘Therapeutic Guidelines: Antibiotic’ nomogram is a valid approach to dosage estimation, but only when used in patients with normal renal function. Simple manual calculations are a suitable alternative in patients with renal impairment.