Patient & Drug Parameters
| CrCl (mL/min) | Dose | Interval | Monitoring |
|---|
| ≥ 60 | 7 mg/kg | Q24h | 6-hr post-infusion level |
| 40–59 | 7 mg/kg | Q36h | 6-hr post-infusion level |
| 20–39 | 7 mg/kg | Q48h | 12-hr post-infusion level |
| < 20 | Traditional dosing; once-daily not recommended |
IBW male = 50 + 2.3 × (ht_in − 60); IBW female = 45.5 + 2.3 × (ht_in − 60)
If BMI > 30: ABW = IBW + 0.4 × (ActualWt − IBW) [use for dosing]
Dose = 7 mg/kg × dosing weight; Interval based on CrCl (Cockcroft-Gault)
Peak target: 5–10 mg/L (6-hr post-infusion); Trough target: <1 mg/L
Traditional targets: Peak 5–10 mg/L, Trough <1 mg/L. Once-daily contraindicated in pregnancy, burns >20% BSA, ascites, dialysis, endocarditis (use traditional dosing). Hartford nomogram: obtain single level 6–14h post-infusion to determine interval adequacy.
