Detectable serum tobramycin concentrations in a patient with renal dysfunction receiving tobramycin by inhalation

Langley, A.; Cottingham, Lauren

doi:10.2146/ajhp100683

Cited by 5 publications

(3 citation statements)

References 4 publications

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“…A few case reports have described patients with renal dysfunction receiving tobramycin inhalation with high trough levels of 10.6, 5 8.8, 6 19.5, 7 2.5 8 and 13.4 mg/L 9 and a peak level of 2.1 mg/L. 10 They received 80 -300 mg twice daily, 5 300 mg twice daily 6 -8,10 or 600 mg twice daily 9 for 5 -25 days. Four patients were ventilated, 5,8 -10 one had bronchopulmonary dysplasia, 5 one was a lung transplant recipient 6 and one had bronchiectasis.…”

mentioning

confidence: 99%

High tobramycin serum concentrations after tobramycin inhalation in a child with renal failure

Velde

Emonts

Verbruggen

et al. 2014

Journal of Antimicrobial Chemotherapy

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mentioning

confidence: 99%

High tobramycin serum concentrations after tobramycin inhalation in a child with renal failure

Velde

Emonts

Verbruggen

et al. 2014

Journal of Antimicrobial Chemotherapy

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“…However, these observations do not apply to non-CF patients with renal dysfunction, and the dosing of inhaled tobramycin in the patient with renal dysfunction has not been well studied. Case reports [2][3][4][5][6][7][8] have suggested that systemic accumulation of inhaled tobramycin may occur in patients with renal dysfunction. Several patients in these case reports developed toxicities due to elevated serum trough concentrations, including 2 patients with vestibular injury and one with hearing loss.…”

Section: Discussionmentioning

confidence: 99%

Therapeutic Drug Monitoring of Inhaled Tobramycin in a Post–Hematopoietic Cell Transplant Patient With Bronchiolitis Obliterans and End-Stage Renal Disease

Trone¹,

Hall²

2020

The Journal of Pediatric Pharmacology and Therapeutics

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There are no widely accepted dose alterations for inhaled tobramycin in the setting of renal dysfunction, and serum concentrations are not typically monitored. Herein we describe a case report of a 16-year-old female with a history of 2 hematopoietic cell transplants and a kidney transplant who received inhaled tobramycin for chronic Pseudomonas aeruginosa management. The patient developed chronic kidney disease, and tobramycin concentrations were monitored. Initially she received a reduced dose of inhaled tobramycin, with repeated doses based on serum concentrations. The dose was increased, but serum concentrations obtained the following day remained higher than desired, leading to a suspicion of delayed systemic absorption. Tobramycin administration was changed from immediately prior to dialysis to the evening prior to the next day's dialysis session, and serum concentrations were consistently <1 mg/L postdialysis. In conclusion, systemic absorption of inhaled tobramycin in non–cystic fibrosis (CF) patients may differ compared to that observed in CF patients. Renal dysfunction may lead to systemic accumulation of inhaled tobramycin, and the timing of inhaled tobramycin administration with respect to dialysis has a potentially significant influence on drug clearance. Thus, monitoring may be required. Further cases are required to verify these observations.

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“…14 Case reports have indicated subjects developed AKI and vestibular toxicity. [15][16][17][18][19] Risk factors associated with systemic absorption of inhaled tobramycin and subsequent development of adverse effects remain unclear. Systemic absorption following inhaled tobramycin is likely multifactorial and could be due to factors such as AKI, chronic kidney disease, positivepressure ventilation, diminished acute or chronic lung function with or without structural lung pathologies, or airway obstructions (eg, mucous plugs).…”

Section: Introductionmentioning

confidence: 99%

Assessment of Detectable Serum Tobramycin Concentrations in Patients Receiving Inhaled Tobramycin for Ventilator-Associated Pneumonia

et al. 2021

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BACKGROUND: Inhaled tobramycin can be used for empiric or definitive therapy of ventilator-associated pneumonia (VAP) in mechanically ventilated patients. This is believed to minimize systemic exposure and potential adverse drug toxicities including acute kidney injury (AKI). However, detectable serum tobramycin concentrations have been reported after inhaled tobramycin therapy with AKI. METHODS: This retrospective, observational study evaluated mechanically ventilated adult subjects admitted to ICUs at a large, urban academic medical center that received empiric inhaled tobramycin for VAP. Subjects were separated into detectable (ie, 6 0.6 mg/L) or undetectable serum tobramycin concentration groups, and characteristics were compared. Independent predictors for detectable serum tobramycin concentration and new onset AKI during or within 48 h of therapy discontinuation were assessed. RESULTS: Fifty-nine inhaled tobramycin courses in 53 subjects were included in the analysis, of which 39 (66.1%) courses administered to 35 (66.0%) subjects had detectable serum tobramycin concentrations. Subjects with detectable serum tobramycin concentrations were older (57.1 y 6 11.4 vs 45.9 615.0, P 5 .004), had higher PEEP (9.2 cm H 2 O [7.0-11.0] vs 8.0 [5.6-8.9], P 5 .049), chronic kidney disease stage 6 2 (10 [29.4%] vs 0 [0%], P 5 .009), and higher serum creatinine before inhaled tobramycin therapy (1.26 mg/dL [0.84-2.18] vs 0.76 [0.47-1.28], P 5 .004). Age (odds ratio 1.09 [95% CI 1.02-1.16], P 5 .009) and PEEP (odds ratio 1.47 [95% CI 1.08-2.0], P 5.01) were independent predictors for detectable serum tobramycin concentration. Thirty-seven subjects had no previous renal disease or injury, of which 9 (24.3%) developed an AKI. Sequential Organ Failure Assessment score (odds ratio 1.72 [95% CI 1.07-2.76], P 5 .03) was the only independent predictor for AKI. CONCLUSIONS: Detectable serum tobramycin concentrations were frequently observed in critically ill, mechanically ventilated subjects receiving empiric inhaled tobramycin for VAP. Subject age and PEEP were independent predictors for detectable serum tobramycin concentration. Serum monitoring and empiric dose reductions should be considered in older patients and those requiring higher PEEP.

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Detectable serum tobramycin concentrations in a patient with renal dysfunction receiving tobramycin by inhalation

Cited by 5 publications

References 4 publications

High tobramycin serum concentrations after tobramycin inhalation in a child with renal failure

High tobramycin serum concentrations after tobramycin inhalation in a child with renal failure

Therapeutic Drug Monitoring of Inhaled Tobramycin in a Post–Hematopoietic Cell Transplant Patient With Bronchiolitis Obliterans and End-Stage Renal Disease

Assessment of Detectable Serum Tobramycin Concentrations in Patients Receiving Inhaled Tobramycin for Ventilator-Associated Pneumonia

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