Timing of inhaled tobramycin affects assessment of intravenous tobramycin pharmacokinetic monitoring

Stenbit, Antine E.; Bullington, Wendy; Heh, Julie; Flume, Patrick A.

doi:10.1016/j.jcf.2012.11.007

Cited by 4 publications

(2 citation statements)

References 11 publications

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“… 5 In line with these data, a clinically significant change in the tobramycin trough has been reported when inhaled and intravenous tobramycin is administered concurrently. 6 And previous case reports have documented the occurrence of falsely elevated serum tobramycin levels in patients receiving both inhaled and intravenous tobramycin due to contamination of finger-prick blood samples by the nebulized drug. 7 – 9 However, because the inhaled antibiotics were discontinued upon admission to the hospital, this can be ruled out as a potential cause.…”

Section: Discussionmentioning

confidence: 99%

Clinical impact of laboratory error on therapeutic drug monitoring of once-daily tobramycin in cystic fibrosis: Case series

Prescott

Mancuso

2014

SAGE Open Medical Case Reports

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Once-daily dosing intravenous tobramycin is commonly used to treat cystic fibrosis pulmonary exacerbations. Clinicians often utilize historical therapeutic drug monitoring data to individualize the dose among patients who have been treated with tobramycin previously. This case series involves three patients with cystic fibrosis who had supra-therapeutic tobramycin levels despite use of a once-daily dosing that produced therapeutic drug levels during a previous hospital admission, raising questions about the validity of these levels. Investigation into several potential sources of error led to the discovery of an analyzer error in the laboratory. Once the laboratory’s tobramycin analyzer was recalibrated, the reported levels were comparable to historical levels. This case series emphasizes the clinical importance of critically analyzing reported levels, and specifically, the importance of utilizing past therapeutic drug monitoring data, if available, for all patients treated with intravenous tobramycin. If a patient was therapeutic on a similar dose of tobramycin during a previous admission, a dose adjustment may not be necessary, and clinicians should consider repeating levels while pursuing alternative explanations for the discrepant serum levels.

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Section: Discussionmentioning

confidence: 99%

Clinical impact of laboratory error on therapeutic drug monitoring of once-daily tobramycin in cystic fibrosis: Case series

Prescott

Mancuso

2014

SAGE Open Medical Case Reports

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“…However, a recent study investigated the effect of inhaled tobramycin on serum concentrations in 20 adult CF patients admitted to the hospital for APE and concomitantly treated with parenteral tobramycin [26]. TIS were given 5-9 hours after the IV dose.…”

Section: Pseudomonas Endocarditismentioning

confidence: 99%

Current Perspectives: Therapeutic Uses of Tobramycin

Reyes¹,

Zhao²,

Buensalido³

2014

J Pharmacovigilance

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Clinical applications of pulmonary delivery of antibiotics

Flume

VanDevanter

2015

Advanced Drug Delivery Reviews

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The treatment of infection typically involves administration of antibiotics by a systemic route, such as intravenous or oral. However, pulmonary infections can also be approached by inhalation of antibiotics as the infection is more directly accessible via the airways, making inhalation delivery essentially topical administration. This approach offers deposition of high antimicrobial concentrations directly at the site of infection but with a potentially reduced systemic exposure. This review covers the evidence for aerosolized antibiotics for the treatment of a number of conditions such as cystic fibrosis (CF), where it has become the standard of care for chronic infection, as well as non-CF bronchiectasis, non-tuberculous mycobacteria, and ventilator-associated infection where such therapy does not have an approved indication but has been used with increasing frequency.

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Timing of inhaled tobramycin affects assessment of intravenous tobramycin pharmacokinetic monitoring

Abstract: Trough tobramycin concentrations were significantly influenced in some CF patients (45%), suggesting that timing of the inhaled dose should be considered when interpreting PK measures of IV tobramycin dosing.

Cited by 4 publications

References 11 publications

Clinical impact of laboratory error on therapeutic drug monitoring of once-daily tobramycin in cystic fibrosis: Case series

Clinical impact of laboratory error on therapeutic drug monitoring of once-daily tobramycin in cystic fibrosis: Case series

Current Perspectives: Therapeutic Uses of Tobramycin

Clinical applications of pulmonary delivery of antibiotics

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