A survey of once‐daily dosage tobramycin therapy in patients with cystic fibrosis

Abstract

The purpose of this study was to quantify the prevalence of once-daily dosage of tobramycin (ODDT) among Cystic Fibrosis Foundation-accredited care centers and affiliated programs (CFFACCs) and characterize the ODDT approaches used by these institutions. An anonymous cross-sectional survey of CFFACCs was performed using an electronic survey tool. This tool was electronically mailed to the program directors. Eighty-four out of 195 institutions completed the survey (response rate = 43%). Fifty-one (61%) of 84 centers reported using ODDT. Of those 51 institutions, 34 (67%) use a dosage of 10 mg/kg/dose. Serum creatinine was measured routinely in 51 centers (100%) with weekly monitoring being used in 40 centers (78%). Audiometric evaluation was performed routinely in 22 (43%) centers with annual assessment performed in 14 (64%) of these 22 centers. In conclusion, a majority of responding institutions use ODDT. The most common reported dosage is 10 mg/kg. Serum creatinine was routinely measured in all institutions with weekly assessment being the most common frequency. Audiometic assessment is routinely performed in <50% of centers. Of the institutions performing audiograms routinely, annual assessment is the most common frequency.

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

“…4 According to recent surveys, the most commonly used intravenous antipseudomonal antibiotic classes were beta-lactams (98%) and aminoglycosides (61%-94.3%). [5][6][7] These surveys also elicited interesting results regarding the dosage strategies currently used by care centers. [5][6][7] Previous surveys of CF centers revealed that recommended doses and dosage regimens are not used by a substantial number of CF centers despite CFF, European, and UK CF Trust Working Group recommendations, and literature confirming the efficacy and safety of larger than Food and Drug Administration-approved doses for beta-lactam agents and once-daily aminoglycosides.…”

A Survey of Extended-Interval Aminoglycoside Dosing Practices in United States Adult Cystic Fibrosis Programs

“…8 Further comparing these data with pediatric CF program data collected as part of this study (following the release of the Cystic Fibrosis Foundation pulmonary exacerbation guidelines) indicates that the use of EID is essentially the same in pediatric and adult CF programs across the United States. 19 That said, the overall use of this regimen in the adult CF population is likely more common because the use of EID in pediatric CF varies based on age with its use being most common in adolescents and least common in younger pediatric patients, and because a higher percentage of adult CF programs frequently or always use EID.…”

“…8 This follow-up survey indicates that the vast majority of adult CF programs (94%) now use EID (as once-daily or twice-daily dosing) in the treatment of pulmonary exacerbations, with 83% of adult CF programs using once-daily EID exclusively. That noted, the percentage of adult CF programs reporting the use of once-daily EID may better reflect current EID practices because a twice-daily dosing approach may not have been considered to be EID by all respondents.…”

“…2,3 Compared with the general adult population, reports indicate the use of EID in patients with cystic fibrosis (CF) to be less common. [3][4][5][6][7][8] In the United States, 61% of pediatric/pediatric-adult CF accredited care centers and affiliate programs were using once-daily dosing of tobramycin as of January 2008. 8 In light of the emergence of safety and efficacy data in the CF population, the Cystic Fibrosis Foundation deemed once-daily aminoglycoside dosing as acceptable for Pseudomonas aeruginosa (grade C recommendation) in its September 2009 pulmonary exacerbation guidelines.…”

“…[3][4][5][6][7][8] In the United States, 61% of pediatric/pediatric-adult CF accredited care centers and affiliate programs were using once-daily dosing of tobramycin as of January 2008. 8 In light of the emergence of safety and efficacy data in the CF population, the Cystic Fibrosis Foundation deemed once-daily aminoglycoside dosing as acceptable for Pseudomonas aeruginosa (grade C recommendation) in its September 2009 pulmonary exacerbation guidelines. [9][10][11][12][13][14][15][16][17][18] A 2009 survey of United States pediatric CF centers and affiliate programs distributed after the publication of these guidelines reported the use of EID (with once-daily or twice-daily dosing) in the pediatric CF population to be 94%, a significant increase from previous reports.…”