Graduate Thesis Or Dissertation
 

Analysis of gentamicin blood levels for the purpose of establishing the potential of pharmacist assisted gentamicin dosing

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  • A random sample of 60 patients receiving gentamicin at a small community hospital was studied. The gentamicin blood levels resulting from the actual doses given and those resulting from doses determined by a method of dose adjustment designed by a pharmacist were predicted and compared. The study shows that 79 percent of the doses given by physicians in this community hospital were within generally accepted guidelines. About 21 percent of the doses given patients were either too high or too low, with these errors made with about equal frequency. By the use of an objective method based on the kinetic parameters of gentamicin, these dosage errors can be eliminated. The pharmacist can eliminate these errors by first calculating creatinine clearance by the method of Siersbak-Nielsen, then using the dosage chart to make dosing recommendations. In selecting patients on gentamicin for monitoring, the creatinine clearance appeared to be the best predictor of inappropriate dosage. If the creatinine clearance was between 20 ml/min and 70 ml/min, the patient was less likely to be dosed inappropriately. A lean body mass less than 60 kg and a serum creatinine over 2.2mg/100m1 also indicate the need for closer scrutiny of the prescribed dose. The use of the pharmacokinetic model and its drug utilization context allows for the quantification of the pharmacist's potential for change in the clinical setting.
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