AMINOGLYCOSIDE POLICY

Prepared by,
Clinical Pharmacist,
HCG MS
 Aminoglycosides:

• Amikacin
• Gentamicin
• Netilmicin
• Sesomicn
• Kanamycin
• Neomycin
• Streptomycin
• Tobramycin
 PURPOSE:

• To promote Rational use of Antibiotics.

• To ensure that Aaminoglycosides are used
Judiciously.
 Spectrum

• Used for Treatment of Serious Infections

caused by Aerobic Gram Negative Bacilli.

• Known to cause serious Nephrotoxicity and

Irreversible Ototoxicity.
• Concomitant use of NSAIDS, Loop diuretics,
Amphotericin, ACE inhibitors increass the
toxicity.
Monitoring:??
• Monitoring of Nephrotoxicity is carried out with the
help of Serum Creatinine levels/ Creatinine
Clearance.
• Normal / baseline Serum Creatinine values: Usually
taken as 0.5 to1.04 mg/dl (1.2 mg/dl).
 Standard Creatinine:

• Expected Creatinine clearance values (expressed as a number

of milliliters per min. 1.72 meters squared of body surface)

Adult males : 97 – 137 ml /min

Adult females : 88 -- 128 ml /min
Pregnancy : may be as high as 150 – 200 ml /min
Elderly : valves diminish with age even if no renal disease
exists, as the GRF declines about 10% per decade after age 50.
 POLICY

• On day 1, aminoglycosides will not be dispensed by pharmacy

without a report of S Creatinine. If the report of Creatinine > 1.2
mg% or Creatinine clearance is less than 60 ml/min pharmacist
will simply draw the attention of treating consultant through CMA
but will provide with the first dose.
• If Creatinine is >1.2 mg % or Cr Cl < 60 ml/min on first dose,
second dose will not be issued without S Creatinine report and the
report should not have jumped up by more than 10%. With every
subsequent dose, in these circumstances, creatinine report will be
asked for by Pharmacy and it should not be rising from day 3
onwards. No aminoglycosides will be dispensed by Pharmacist
without daily stable creatinine report in this scenario.
• If Creatinine is normal(less than 1.2 mg %) or
Cr cl > 60 ml/min with first dose, Creatinine
reports will be needed to issue every fourth
dose. No Aminoglycosides will be dispensed
by Pharmacist without Creatinine report every
fourth day in this scenario.
• Aminoglycosides will not be dispensed to
any patient after day 10 without the written
consent of treating consultant.
THANK YOU