Case study 1: IV Gentamicin 11mg OD (started 28/3/25, 04:27)

Result: 1.03 mcg/ml

What would you suggest?

• Change dosing frequency to 11mg 36hourly

• Continue 11mg OD

• Repeat another sample at 24h post 3rd dose

Case study 2: IV Gentamicin 9mg OD (started 3/4/25, 4pm)

Result: 56.21 mcg/ml (5/4/25 , 4pm)

What would you suggest?

• Repeat a pre level on 6/4/25, 4pm

• Withhold gentamicin, repeat on 6/4/25, 4pm

• Suggest to discontinue in view that the level is expected to be able to cover for total 5 days of treatment

• Other answer

Case 2: IV Gentamicin 9mg OD (started 3/4/25, 4pm)

Result: 56.21 mcg/ml (5/4/25 , 4pm)

Repeated result after 24h: 1.19 mcg/ml (6/4/25, 4pm)

What would you suggest?

• Levels changed too much, repeat again on 7/4/25, 4pm

• Change to 9mg 36hrly, next dose 6/4/25, 4pm

• Change to 9mg 36hrly, next dose 7/4/25, 4am

• Change to 9mg 36hrly, next dose 7/4/25, 4pm

Case 3: IV amikacin 12mg 48hrly

Date started: 26/3/25 (10:30am)

When should TDM sampling be done?

• 27/3/25 (10am)

• 28/3/25

  (10am, at pre-dose)

• 29/3/25 (10am)

• 30/3/25

  (10am, at pre-dose)

Case 3: IV amikacin 12mg 48hrly (started 26/3/25, 10:30)

Result: 7.6 mcg/ml (29/3/25 , 10am)

• Maintain 12mg 48hrly in view that level is <10.5

• Change to 12mg 36hrly

• Change to 12mg 24hrly

• Repeat sample (suspected wrong sampling)

Case 3: IV amikacin 12mg 48hrly (started 26/3/25, 10:30am)

Result: 7.6 mcg/ml (29/3/25 , 10am)

• •Change to 12mg 36hrly.

When should be the next dose?

• 29/3/25, 10pm

• 30/3/25, 10am

• 30/3/25, 10pm

• 31/3/25, 10am

Case 4: IV amikacin 9mg 48hrly (started 24/3/25, 17:10)

When should TDM sampling be done?

• 26/3/25 (4am)

• 26/3/25 (4pm, pre-dose)

• 27/3/25 (4am)

• 27/3/25 (4pm)

Case 4: IV amikacin 9mg 48hrly (started 24/3/25, 17:10)

•Result: 2.55 mcg/ml (27/3/25 , 4pm)

What would you suggest?

• Maintain 12mg 48hrly in view that level is <10.5

• Change to 12mg 36hrly

• Change to 12mg 24hrly

• Repeat sample (suspected wrong sampling)