L. Pharmacokinetic Equations/Calculations

Twelve Steps to Prevent Antimicrobial Resistance Twelve Steps to Prevent Antimicrobial Resistance Transmission Based Isolation Precautions

TwelveSteps to PreventAntimicrobial Resistance

1. Wash your hands! 8. Know when to say “NO” to broad spectrum 1. Wash your hands!2.Vaccinate 8. Knowwhen to say “NO” agents to broad spectrum 2.Vaccinate3. Get the catheters and lines out 9. agents Treat infection - not colonization 3.4. Getthe cathetersandlines out Obtain cultures 9. Treat infection -10. Treat infection not colonization- not contamination 4.5. Obtain cultures Target the pathogen 10. 11. Treat infection - not contamination Stop treatment when infection is cured 5.6. Targetthe pathogen Seek expert input 11. Stop treatmentwhen infection iscured or unlikely 6.7. Seek expertinput Know the local sensitivity patterns 12. or unlikely Prevent transmission 7. Knowthe localsensitivity patterns 12. Prevent transmission

Adopted from the Centers for Disease Control Campaign for Clinicians

Adopted from theCentersfor DiseaseControlCampaign for Clinicians

Transmission Based isolationPrecautions Transmission Based isolation Precautions

TYPES OF PRECAUTIONS FOR INFECTION CONTROL Precaution Gowns TYPES OF PRECAUTIONSGloves FOR INFECTIONMasks CONTROLHands Conditions

PrecautionStandard Gowns If splatteringof Gloves For contactswith If Masks aerosolization Hands ConditionsWASH upon ALL patients Standard If splattering of body fluids or For contacts with mucous If aerosolization or splatteringof WASH upon entering and ALL patients body fluids or bloodis likely mucous membranes, or splattering of body fluids or entering and leaving room blood is likely membranes, non-intact skin body fluids or bloodis likely leaving room non-intact skin and ALL body blood is likely and ALL body fluids fluids UseStandardPrecautions on allpatients. UseTransmissionBased Precautions below inadditiontoStandard

Use Standard Precautions on all patients. Use Transmission Based Precautions below in addition to Standard Precautions CATEGORY SPECIFIC ISOLATION PrecautionsPRECAUTIONS/TRANSMISSION BASED PRECAUTIONS

CATEGORY SPECIFIC ISOLATION PRECAUTIONS/TRANSMISSIONApproved, fit- BASED PRECAUTIONS Airborne Airborne Not necessary Not necessary Not necessary Not necessary Approved, fittested respirator protection and required N-95 mask tested respirator protection and required N-95 mask WASH upon entering and leaving room WASH upon entering and leaving room Tuberculosis or rule out tuberculosis. Respiratory phase of measles and chicken pox Tuberculosisor rule out tuberculosis. Respiratory phase of measles and chicken pox Infectedor colonized Contact Contact Upon entering patient room Upon entering patient room Upon entering room and for all contacts with patient and surfaces or equipment in Upon entering roomand for all contacts with patient and surfaces or equipment in room For suctioning, if organism is in sputum For suctioning,if organism is in sputum WASH upon entering and leaving room WASH upon entering and leaving room Infected or colonized patients, whether bedridden or ambulatory, with wounds or diarrhea: multi-resistant organisms, MRSA, VRE, ESBL, CRE/KPC, or C. patients, whether bedridden or ambulatory, with woundsor diarrhea: multi-resistant organisms, MRSA, VRE, ESBL, CRE/KPC, or C. difficile diarrhea room difficile diarrhea MRSA in sputum, Droplet Droplet Not necessary Not necessary To handle respiratory secretions or suctioning To handle respiratory secretions or suctioning Within three feet of the patient (regular masks) Withinthree feet of the patient (regular masks) WASH upon entering and leaving room WASH upon entering and leaving room MRSA in sputum, Neisseria meningitidis, drug resistant pneumococci, diptheria, pertussis, Neisseria meningitidis, drug resistant pneumococci, diptheria, pertussis, influenza Protective Environment Protective Environment influenza Not necessary Not necessary Not necessary WASH upon entering and leaving room Neutropenia (< 1000 neutrophils), ANC <100 Not necessary Not necessary Not necessary WASH upon entering and leaving room Neutropenia (< 1000 neutrophils),ANC <100 Refer to Policy MCM 111-P26Standardand Transmission Based Precautions

Refer to Policy MCM 111-P26 Standard and Transmission Based Precautions CallInfection Prevention andControlforfurtherguidance atext2654 Call Infection Prevention and Control for further guidance at ext 2654

Pharmacokinetic Calculations Pharmacokinetic Calculations  Pharmacokinetic Calculations

Ideal Body Weight (IBW) Calculation:

Male: 50 kg+ [2.3 kg foreach inchover5 feet]Ideal Body Weight (IBW) Calculation: Female: Male: 45 kg+ [2.3 kg foreach inchover5 feet] 50 kg + [2.3 kg for each inch over 5 feet] Creatinine Clearance (CrCl) usingCockcroft-GaultEquation:Female: 45 kg + [2.3 kg for each inch over 5 feet] Creatinine isexpressedinmL/min Creatinine Clearance (CrCl) using Cockcroft-GaultEquation: CrCl (mL/min) =Creatinine is expressed in mL/min (140 – age) (IBW in kg)* CrCl (mL/min) = 72 (SCr in mg/dL)‡(140 – age) (IBW in kg)* NOTE: For Females multiplyby0.85 72 (SCr in mg/dL)‡

CrCl forelderly patients or when noheight is available: NOTE: For Females multiply by 0.85

CrCl CrCl (mL/min) =(114 – (0.8 *age)) for elderly patients or when no height is available: CrCl (mL/min) = SCr in mg/dL‡(114 – (0.8 *age)) NOTE: For females multiplyby0.9 SCr in mg/dL‡

NOTE: For females multiply by 0.9

*If patientsactual bodyweight islessthan IBW, useactual bodyweight to calculate CrCl *If patients actual body weight is less than IBW, use actual body weight to calculate ‡If patient isunderweight/cachectic,mayconsider roundingCrCl SCr up to 1 mg/dL.1,2 Do not round to 1mg/dL for all patients>60years ofage.3-5‡If patient is underweight/cachectic, may consider rounding SCr up to 1 mg/dL.1,2 Adjusted Body Weight (aminoglycoside dosing) Do not round to 1 mg/dL for all patients > 60 years of age.3-5 Useadjusted bodyweight (AdjBW)whenactual bodyweight(ABW)is≥30%ofideal Adjusted Body Weight (aminoglycoside dosing) body weight (IBW) Use adjusted body weight (AdjBW) when actual body weight (ABW) is ≥ 30% of ideal body weight (IBW) AdjBW = 0.4 (ABW - IBW)+ IBW AdjBW = 0.4 (ABW - IBW) + IBWIBW= Ideal Body Weight (in kg); AdjBW= Adjusted Body Weight; ABW= Actual Body Weight; CrCl= Creatinine clearance; SCr= serumcreatinine IBW= Ideal Body Weight (in kg); AdjBW= Adjusted Body Weight; ABW= Actual Body Weight; CrCl= Creatinine clearance; SCr= serum creatinine

References:

1. Robert S, Zarowitz BJ, Peterson EL, Dumler F. Predictability of creatinine clearance estimates in critically ill patients. Crit Care Med. 1993;21(10):References: 1487-1495. 2. 1. Khuu T, Bagdasarian G, Leung J, et al. Estimating aminoglycoside clearance and creatinine clearance in underweight patients. Am J HealthRobertS,Zarowitz BJ, Peterson EL, Dumler F.Predictability ofcreatinine clearanceestimates incritically ill patients. Crit Care Med. Sys Pharm. 2010;67(4):2741993;21(10):1487-1495. 279. 3. 2. Bertino Khuu T, JS. Measured versus estimated creatinine clearance in patients with low serum creatinine values. Ann Pharmacother. Bagdasarian G,LeungJ, et al. Estimatingaminoglycosideclearanceand creatinineclearancein underweight patients. Am J Health1993;27(12):1439-1442.Sys Pharm. 2010;67(4):274-279. 4. 3. Smythe Bertino M, Hoffman J, Kizy K, Dmuchowski C. Estimating creatinine clearance in elderly patients with low serum creatinine concentrations.JS.Measured versusestimated creatinineclearance in patientswith low serum creatininevalues. Ann Pharmacother. Am J Hosp Pharm. 1994;51(2):1993;27(12):1439-1442. 198-204. 5. 4. Dowling TC, Wang E-S, Ferrucci L, Sorkin JD. Glomerular Filtration Rate Equations Overestimate Creatinine Clearance in Older Individuals Smythe M, Hoffman J, Kizy K,Dmuchowski C.Estimatingcreatinineclearance in elderly patients with low serum creatinineconcentrations. Enrolled in the Baltimore Longitudinal Study on Aging: Impact on Renal Drug Dosing Am J Hosp Pharm. 1994;51(2):198-204. . Pharmacotherapy. 2013;33(9):912-921. 5. Dowling TC,Wang E-S, Ferrucci L, Sorkin JD.GlomerularFiltrationRateEquationsOverestimateCreatinineClearancein Older Individuals Enrolled in the BaltimoreLongitudinalStudy on Aging: Impacton Renal Drug Dosing. Pharmacotherapy. 2013;33(9):912-921. PAGE 78