I don't recommend aminoglycosides as empiric therapy in septic shock or severe sepsis, except in rare circumstances. We have lots of alternatives and risk of nephrotoxicity in that situation is very high. If for some reason, that is what the doctor believes should be used, you could give a loading dose of a maximum of 2 mg/kg but no subsequent doses until level obtained. I would not use once daily dosing either. The best option would be to have your infectious disease specialist look at the empiric therapy regimens that the ED doctors are using and make suggestions for them to use in general. A good reference for your doctors: The Sanford Guide to Antimicrobial Therapy 2013.
Jeffrey Silvers, M.D. Medical Director of Quality, Eden Medical Center Infectious Diseases specialist From: [email protected] [mailto:[email protected]] On Behalf Of Harkey,Jessica Sent: Tuesday, September 17, 2013 10:28 AM To: [email protected] Subject: [Sepsis Groups] Aminoglycoside dosing in severe sepsis/septic shock Hello there. I have been having some discussion with our pharmacists on whether or not patients who present to the ED in severe sepsis or septic shock should receive a full dose of an aminoglycoside (when indicated) within the first hour regardless of Cr clearance? The practice of our ED physicians thus far has been to order a full dose, and now we are getting some feedback from pharmacy to reduce the dose per renal function, which seems appropriate with consecutive doses along with monitoring drug levels. I am concerned about delaying administration. For initial empric therapy what are the rest of you doing in such cases? Any literature available for me to share with the pharmacy? Thank you! Jessica Harkey, RN, BSN, CCRN Sepsis Program Coordinator San Joaquin Community Hospital 661-869-6874 [email protected]<mailto:[email protected]> [cid:[email protected]]
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