Extended
interval (once daily) gentamicin / tobramycin
Take a pre-dose level 18-24 hours
after 1st dose.
Levels should be <1mg/l
Normal renal function - (creatinine
clearance >60ml/min) give next dose when due.Check pre-dose levels
every 3-5 days.
Impaired renal function - monitor
levels daily
Multiple daily
dosing gentamicin / tobramycin
(BD or TDS)
Take trough and peak levels after
24 hours i.e. at the 3rd dose for BD dosing and at the 4th dose for
TDS dosing.
Pre-dose / trough level 0.5 to 2.0mg/l
Peak level 6.0 to 10.0mg/l
Normal renal function - monitor
levels every 3-5 days
Impaired renal function - monitor
levels daily
Vancomycin
Take pre-dose levels prior to 3rd dose.
Give the 3rd dose as prescribed and
amend 4th dose according to levels
Pre-dose level 5-15mg/l
Normal renal function - (creatinine
clearance >60ml/min) check levels every 3-5 days.
For severe infections higher levels
may be advised by microbiology.
Teicoplanin
Monitoring is required for patients
with impaired renal function / to ensure therapeutic plasma levels.
Ensure that usual BD loading dose
is given
Take pre-dose level on day 4 to 7.
Severe infection - pre-dose level 20-60mg/l
Mild - moderate infection -
pre-dose level 10-60mg/l
Regular monitoring may be required
in renal impairment
Assays are performed on Tuesdays
and Fridays
Amikacin -
(multiple daily dosing)
Pre-dose level 5-10mg/l
1 hour peak 20-25mg/l
Voriconazole
Pre-dose level 0.25 - 6.00 mg/l
(Mon and Thurs)
For therapeutic drug monitoring
assays are performed twice daily by biochemistry, including weekends.
For further information seek advice
from microbiology or biochemistry.
The
following are carried out at the mycology reference lab. For further
advice contact ext 2124.
Itraconazole
To ensure therapeutic levels as
problematic absorption.
Random level 5-15mg/l (oral therapy)
For IV therapy please send
pre-dose, 1 hour post dose and 4-6 hours post dose samples
Flucytosine
Monitor levels at 2nd to 3rd dose
and twice weekly thereafter. Monitor more frequently in renal impairment
Pre-dose level 30-40mg/l
Peak (30 minutes post IV infusion
or 2 hours post oral therapy) 70-80mg/l
Levels >100mg/l are potentially toxic