Tobramycin and Beta-Lactam Antibiotic Use in Cystic Fibrosis Exacerbations: A Pharmacist Approach

Zobell, Jeffery T.; Epps, Kevin; Kittell, Frederick; Sema, Clarissa M.; McDade, Erin; Peters, Stacy; Duval, Mariela A; Pettit, Rebecca S.

doi:10.5863/1551-6776-21.3.239

Cited by 11 publications

(22 citation statements)

References 20 publications

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“…In clinical care, MIC testing is often not performed, or if it is, results are not back for several days after start of treatment. Therefore, AUC 24 alone is routinely utilized to guide dose individualization for tobramycin in patients with CF 3 . Traditional approaches to estimating AUC 24 utilize log‐linear regression (LLR) equations based on two timed tobramycin concentrations 13 .…”

Section: Introductionmentioning

confidence: 99%

Area under the curve achievement of once daily tobramycin in children with cystic fibrosis during clinical care

Brockmeyer

Wise

Burgener

et al. 2020

Pediatric Pulmonology

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Background The area under the concentration‐time curve over 24 hours (AUC24) is frequently utilized to monitor tobramycin exposure in children with cystic fibrosis (CF). An understanding of exposure target achievement during clinical implementation of an AUC24 based approach in children is limited. Methods A retrospective chart review was performed in children with CF treated with once daily tobramycin and drug concentration monitoring at a pediatric CF center. During clinical care AUC24 was estimated using a traditional log‐linear regression approach (LLR). AUC24 was also estimated retrospectively using a pharmacokinetic model‐based Bayesian forecasting approach (BF). AUC24 achievement after both approaches were compared. Results In 77 treatment courses (mean age, 12.7 ± 5.0 years), a target AUC24 100 to 125 mg h/L was achieved after starting dose in 21 (27%) and after initial dose adjustment in 35 (45%). In the first 7 days of treatment, 24 (32%) required ≥3 dose adjustments, and the mean number of drug concentrations measured was 7.1 ± 3.2. Examination of a BF approach demonstrated adequate prediction of measured tobramycin concentrations (median bias −2.1% [95% CI −3.1 to −1.4]; median precision 7.6% [95% CI, 7.1%‐8.2%]). AUC24 estimates utilizing the BF approach were higher than the LLR approach with a mean difference of 6.4 mg h/L (95% CI, 4.8 to 8.0 mg h/L). Conclusions Achievement of a narrow AUC24 target is challenging during clinical care, and dose individualization is needed in most children with CF. Implementing a BF approach for estimating AUC24 in children with CF is supported.

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Section: Introductionmentioning

confidence: 99%

Area under the curve achievement of once daily tobramycin in children with cystic fibrosis during clinical care

Brockmeyer

Wise

Burgener

et al. 2020

Pediatric Pulmonology

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“…A limitation of the study is the low response rate (45%) of pharmacists affiliated with CFF-accredited care centers; however, the response rate is comparable to that of previous antibiotic utilization surveys (42%-58%). 6,[15][16][17][18] Since over half of the pharmacists did not respond, the results may not be generalized.…”

Section: Discussionmentioning

confidence: 99%

Vancomycin Dosing and Monitoring in the Treatment of Cystic Fibrosis: Results of a National Practice Survey

Pettit

Peters

McDade

et al. 2017

The Journal of Pediatric Pharmacology and Therapeutics

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OBJECTIVES Vancomycin is commonly used in patients with cystic fibrosis (CF) to treat acute pulmonary exacerbations, but few guidelines exist to help dose and monitor patients. The objective of this study was to assess vancomycin use and monitoring strategies at Cystic Fibrosis Foundation (CFF)-accredited centers in hopes of developing and implementing vancomycin dosing and monitoring standards. METHODS An anonymous national cross-sectional survey of pharmacists affiliated with CFF-accredited pediatric and/or adult centers was performed by using Surveymonkey.com. The survey consisted of 3 sections: (1) CF Center Demographic Information (10 questions); 2) vancomycin use in pediatric CF patients (31 questions); and 3) vancomycin use in adult CF patients (29 questions); it was administered from March 9, 2015, to April 13, 2015. RESULTS The survey was completed by 31/69 (45%) pharmacists and 28 (90.3%) reported using vancomycin in the pediatric population. The most common initial starting dose for pediatric patients was 15 mg/kg/dose (57.1%) and every 6 hours was the most common dosing frequency (67.9%). The most common monitoring strategy was collection of a trough concentration (92.9%) with 57.7% of pharmacist targeting a range of 15 to 20 mg/L. The most common initial starting vancomycin dose in adults with CF was 15 mg/kg/dose (61.5%), and initial frequency of every 8 hours (73.1%). The most common monitoring strategy was a trough concentration (96.2%) with 83.3% of pharmacists reporting a goal trough range of 15 to 20 mg/L. CONCLUSIONS The most common vancomycin dosing reported was 15 to 20 mg/kg/dose every 6 hours (pediatric) and 15 to 20 mg/kg/dose every 8 to 12 hours (adults). Serum concentrations measured to meet monitoring parameters of trough concentrations of 15 to 20 mg/L, or area under the curve to minimum inhibitory concentration ratio > 400, were the same in both pediatric and adult patients.

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“…Once-daily dosing for aminoglycosides is preferred [68]. The most commonly used beta-lactams in CF Foundation-accredited centers include ceftazidime, piperacillin-tazobactam, meropenem, and cefepime [74].…”

Section: Antibiotic Therapymentioning

confidence: 99%

“…Some suspect this is due to lower protein binding and alterations in the volume of distribution due to chronic malnutrition [86]. Two commonly classes of antibiotics prescribed during a PEx, antipseudomonal beta-lactams and aminoglycosides, have interesting pharmacokinetic implications [74]. Although beta-lactam serum drug levels are not routinely measured, significant changes in antibiotic clearance can occur during PEx.…”

Section: Pharmacokinetic Considerationsmentioning

confidence: 99%

“…It is standard practice in pediatric CF Foundation-accredited care centers and affiliate programs to monitor aminoglycoside serum concentrations during PEx [90]. Tobramycin is typically given at 10 mg/ kg daily and is initially monitored with two random levels to calculate the maximum concentration (Cmax), with a goal Cmax of 20-40 mg/L [74]. A trough level is drawn 1 week after therapeutic dose attainment [90].…”

Section: Pharmacokinetic Considerationsmentioning

confidence: 99%

See 1 more Smart Citation

Acute and Chronic Infection Management in CF

Allen

Borick

2020

Cystic Fibrosis in Primary Care

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Tobramycin and Beta-Lactam Antibiotic Use in Cystic Fibrosis Exacerbations: A Pharmacist Approach

Cited by 11 publications

References 20 publications

Area under the curve achievement of once daily tobramycin in children with cystic fibrosis during clinical care

Area under the curve achievement of once daily tobramycin in children with cystic fibrosis during clinical care

Vancomycin Dosing and Monitoring in the Treatment of Cystic Fibrosis: Results of a National Practice Survey

Acute and Chronic Infection Management in CF

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