I believe PkDose for Windows 1.0 would be helpful in my practice. Enclosed is $49 (U.S.) for the complete program that will print my results as well as store them in comma delimited ASCII format.,
Enclosed with this form is my check or money order payable to:,
Bruce J. Kiacz, R.Ph.
5434 Whitehouse-Spencer Road
Whitehouse, OH 43571C
Ship To:,
Use this field to record the patient's name. It is suggested that you be consistent in your entries and always enter your patient's name in the order LAST NAME, FIRST NAME , MIDDLE INITIAL.
PkDose will automatically enter the current date as a default, The user may change this if desired.
35328
Use this field to record the location of your patient at your institution. Any combination of alphanumeric characters may be used.
Use this field to record the name of the physician requesting the consult. It is probably a good idea to use the LAST NAME, FIRST NAME, MIDDLE INITIAL format.
PkDose provides a pick list of the most common uses of aminoglycosides or vancomycin. You may type in the diagnosis or use the mouse or arrow keys to scroll down the list of choices and select the disease state that most closely fits your patient.
Sepsis
Pneumonia/Lung Infection
Cellulitis
Wound/Soft Tissue Infection
Urinary Tract Infection
Pyelonephritis
Endocarditis
Meningitis
Peritonitis
Post-Operative
P.I.D.
Empiric Therapy
This patient is less than 16 years old. Prospective pediatric dosing is not a function of PkDose. You will be returned to the main menu.
Begin
Use this field to enter the patient's age in years. The loading dose module of PkDose was not designed for use in pediatric patient populations and will automatically return to the main menu if an age of less than 16 years is entered. You may, however, calculate safe and effective maintenance doses for pediatric patients using measured serum drug concentrations and either of the other two serum concentration-based PkDose modules.
0.3937
A minimum height of 60 inches (152.4 cm) will be employed for all calculations
PkDose employs the method of Devine to calculate ideal body weight. Since this formula requires a minimum height of 60 inches, PkDose will accept a lesser entry but will perform IBW calculations as if the patient were 60 inches tall. Note also that ideal body weight is used in the calculation of creatinine clearance which may be, therefore, overstated in patients less than 60 inches tall.
Use this field to enter the patient's actual weight in pounds. Patients who weigh less than their ideal body weight will be assigned a dosing weight based on their actual body weight for the aminoglycosides and ideal body weight for vancomycin. For those individuals receiving aminoglycosides and whose weight is greater than IBW, a dosing weight will be calculated using their ideal body weight plus a percentage of excess body weight. For gentamicin the percentage is 43.7%, for tobramycin it is 58% and for amikacin it is 38%. Overweight patients receiving vancomycin will be dosed on their actual body weight up to a maximum of 1.5 times their ideal body weight.
The only valid entries in this field are M or F. Entering any other letter or number will result in the default choice of F.
To reduce overestimation of creatinine clearance and elimination constant Ke, a minimum serum creatinine value of 1.0 will be used.
Use this field to enter the patient's most recent serum creatinine in mg/dl. PkDose employs the Cockcroft-Gault equation to calculate creatinine clearance. This value is then used in combination with an estimated volume of distribution to calculate the estimated elimination constant Ke. Hence, an accurate serum creatinine is essential to ensure an accurate estimated regimen for your patient. Dehydration, overhydration, aggresive diuresis, malnutrition and other factors may affect the accuracy of serum creatinine measurements. Be sure to familiarize yourself with disease states and therapies that may affect serum creatinine and, therefore, the accuracy of your recommendations.
PkDose will assign a mimimum value of 1.0 if the entered serum creatinine is less than 1. This is done to prevent overestimation of creatinine clearance and elimination constant Ke.
PkDose uses the Cockcroft-Gault equation to calculate the creatinine clearance of adults 21 years of age, or older. That is, Creatinine Clearance = ((140-Age) * Ideal Body Weight)/(72 * Serum Creatinine). For females, the result is multiplied times 0.85.
For females ages 13 to 21, Creatinine Clearance = (0.55 * Height in cm)/Serum Creatinine.
For males ages 13 to 21, Creatinine Clearance = (0.7 * Height in cm)/Serum Creatinine.
PkDose provides actual body weight in kilograms for convenience in calculating other statistics.
Ideal Body Weight has been calculated for an age of 1 year.
PkDose employs the method of Devine for calculating ideal body weight in adults over the age of 18. For males IBW = 50kg + (2.3kg * each inch height > 60). For females IBW = 45.5kg + (2.3kg * each inch height > 60).
For males that are less than 18 years old but at least 60 inches tall, IBW = 39kg + (2.27kg * each inch height >60). For females less than 18 years old, but at least 60 inches tall, IBW = 42.2kg + (2.27 * each inch height >60).
For all others who are less than 18 years old and less than 60 inches tall, IBW = ((Height in cm)
* 1.65)/1000.
PkDose will calculate an estimated regimen for four different antibiotics. Use the mouse or arrow keys to select your choice.
Gentamicin
Tobramycin
Amikacin
Vancomycin
Many institutions assign a temporary ACCOUNT NUMBER to identify each admission, as well as a permanant MEDICAL RECORD NUMBER that identifies an individual patient. PkDose, therefore, provides both Account Number and Medical Record Number fields for your use. In the event that your institution does not use two identifiers, one may be left blank, or used to record other patient characteristics.
Gentamicin (
Tobramycin (
Amikacin (
PkDose will select a desired trough concentration based on your selection of diagnosis and medication. You may, of course, change this at any time to get a revised estimated loading dose and estimated dosing interval.
Gentamicin
Pneumonia/Lung Infection
gentamicin (
Tobramycin
Pneumonia/Lung Infection
Tobramycin (
Amikacin
Pneumonia/Lung Infection
Amikacin (
PkDose will select a desired peak serum concentration based on your selection of diagnosis and medication. You may, of course, change this at any time to get a revised estimated loading dose and estimated dosing interval.
Many institutions assign a temporary ACCOUNT NUMBER to identify each admission, as well as a permanent MEDICAL RECORD NUMBER that identifies an individual patient. PkDose, therefore, provides both Account Number and Medical Record Number Fields for your use. In the event that your institution does not use two identifiers, one may be left blank, or used to record other patient characteristics.
Gentamicin
0.25)/
Tobramycin
0.25)#
Amikacin
0.27)
Vancomycin
0.75)
0.35)
0.75)
PkDose will suggest an initial volume of distribution based on the chosen antibiotic. It is suggested that the user accept this value to design the initial suggested regimen. Then, after the initial dose and interval are selected, return to the volume of distribution field and enter a range of possible, anticipated values. If your range of simulated distribution volumes cause an excessive peak or trough using your initial dose and interval, adjust the dose and interval until acceptable peaks and troughs are obtained for your range of possible distribution volumes.
The range of distribution volumes reported in the literature for gentamicin and tobramycin are 0.15 to 0.5 l/kg. For Amikacin the range is 0.15 to 0.4 l/kg. For Vancomycin, the range is 0.5 to 1.2 l/kg. Bear in mind that CHF and ascites greatly increase volume of distribution, while dehydration and aggresive diuresis decrease volume of distribution. Be aware of your patient's disease state and ongoing therapies and their effects on volume of distribution when designing your regimen.
PkDose estimates the elimination constant using creatinine clearance and estimated volume of distribution. This method, therefore, provides the user with a powerful engine to simulate the effects of a range of distribution volumes on the final suggested regimen. After designing a regimen based on the accepted volume of distribution for the antibiotic chosen, the user may change the distribution volume to either end of its normal range and see the effect on the suggested regimen. By adjusting the suggested dose and interval, a new regimen may be designed that would satisfy provide a safe peak/trough series over the entire range of possible distribution volumes.
Gentamicin (
Tobramycin (
Amikacin (
Gentamicin (
Tobramycin (
Amikacin (
PkDose will generate an estimated loading dose as follows: For gentamicin and tobramycin the loading dose is 2 mg/kg of dosing weight, for amikacin 7.5 mg/kg of dosing weight, and for vancomycin 20 mg/kg of dosing weight.
On occasion, the result will be an odd number that would be difficult to compound, so it is up to the user to round the loading dose to the most convenient, measureable amount and enter that quantity as the suggested loading dose.
PkDose will generate an estimated maintenance dose based on the the desired peak and trough serum concentrations. This dose and associated dosing interval may be an odd number. It is up to the user to enter a suggested dose and interval that will be convenient to manufacture and administer.
NOTE: it is usually NOT RECOMMENDED to prospectively dose these antibiotics less than every 8 hours.
PkDose will generate an estimated dosing interval based on the estimated maintenance dose and the desired peak and trough serum concentrations. As with the estimated loading and maintenance doses, this interval may be an odd number. It is up to the user to select a more convient suggested interval that will yield acceptable peak and trough serum concentrations.
NOTE: IT IS NOT RECOMMENDED TO PROSPECTIVELY DOSE AMINOGLYCOSIDE ANTIBIOTICS AT INTERVALS OF LESS THAN 8 HOURS ! PKDOSE WILL DEFAULT TO A MINIMUM INTERVAL OF 8 HOURS, CONSEQUENTLY TROUGH VALUES FOR ESTIMATED MAINTENANCE DOSES MAY BE LESS THAN THE DESIRED TROUGH. IT IS STRONGLY SUGGESTED NOT TO SHORTEN THE INTERVAL TO LESS THAN 8 HOURS OR INCREASE THE DOSE TO ACHIEVE HIGHER TROUGH CONCENTRATIONS.
AT A MINIMUM, USE AN 8 HOUR DOSING INTERVAL UNTIL ACCURATE SERUM PEAK AND TROUGH CONCENTRATIONS CAN BE OBTAINED!
Use this field to enter the length of infusion of the antibiotic dose in hours. It is a good idea to establish a consistant protocol to minimize errors. Most institutions choose either 0.5 or 1 hour infusion times.
Use this field to enter a suggested loading dose. The user should select a value that is close to the estimated loading dose, but easily compounded. For instance 120 mg of gentamicin which is 3 ml, rather than a dose of 117 mg which is a nearly unmeasurable 2.925 ml.
Use this field to enter a suggested maintenance dose. Select a value that is close to the estimated maintenance dose, but easily compounded. For instance 80 mg of gentamicin, which is 2 ml, rather than 83 mg which is a difficult to measure 2.075 ml.
Use this field to enter a suggested dosing interval. The user should select a value that is close to the estimated dosing interval, but convient to administer, such as every 12 hours, rather than every 10.5 hours.
IT IS NOT RECOMMENDED THAT AMINOGLYCOSIDE ANTIBIOTICS BE PROSPECTIVELY DOSED AT LESS THAN 8 HOUR INTERVALS. MAKE IT A POLICY THAT THE MINIMUM DOSING INTERVAL FOR PROSPECTIVE USE IS NO LESS THAN EVERY 8 HOURS!
At this point, with a suggested dose and interval selected, the user may wish to return to the volume of distribution field and enter a different value to see its effect on the peak and trough serum concentrations. By trying a variety of higher and lower values, the user can simulate the effects of unforseen alterations in distribution volume. Then, by re-adjusting the suggested maintenance dose and interval, a regimen can be designed that will provide safe peak and trough serum concentrations for a variety of possible distribution volumes.
In this field, PkDose will display the calculated peak serum concentration for the suggested dose and interval entered by the user.
In this field, PkDose will display the calculated trough serum concentration for the suggested dose and interval entered by the user.
begin
Shareware
Vancomycin (
Gentamicin (
0.437
Tobramycin (
Amikacin (
Dosing Weight is based on the choice of antibiotic and the patient's actual weight. Patients who weigh less than their ideal body weight are dosed on their actual body weight for aminoglycosides and vancomycin. Overweight vancomycin patients are dosed on their actual body weight up to a maximum of 1.5 times ideal body weight. Overweight aminoglycoside patients are dosed on their ideal body weight plus a percentage of their excess body weight. For gentamicin the percentage of excess weight used is 43.7%, for tobramycin it is 58%, and for Amikacin it is 38%.
PkDose provides this field for user comments.
PkDose provides creatinine clearance in milliliters per minute per kilogram of dosing weight for convenience in calculating other statistics.
PkDose provides height in centimeters for convenience in calculating other statistics.
0.425
0.725
4.2745
10000
PkDose calculates body surface area using the method of DuBois and DuBois for convience in calculating other statistics.
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