Therapeutic drug monitoring of once daily tobramycin in cystic fibrosis—caution with trough concentrations

Coulthard, Kingsley; Peckham, Daniel; Conway, S.P.; Smith, Carol A.; Bell, Jan M.; Turnidge, John

doi:10.1016/j.jcf.2006.05.015

Cited by 45 publications

(33 citation statements)

References 30 publications

(58 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The therapeutic drug monitoring (TDM) approach of a trough gentamicin concentration of <1 or <2 mg/L is in line with that recommended by others – for example, the UK CF Trust 5 . However, we believe that such an approach, which is derived from TDM methodology for conventional 8‐hourly dosing, has the potential for significantly greater exposure to the aminoglycosides, as measured by area under the plasma concentration–time curve (AUC), than typically associated with conventional 8‐hourly dosing using the ‘peak and trough’ TDM approach 6 . Like Alvarez in 1991, 7 we advise caution in adopting the TDM approach successfully used for 8‐hourly dosing (namely a trough <1 or <2 mg/L) and apply it to extended interval dosing.…”

supporting

confidence: 74%

“…demonstrated a high prevalence of abnormal renal function in CF patients with normal serum creatine and urea values 3 . We have demonstrated significantly reduced tobramycin clearances in CF patients again with normal serum creatinines 6 …”

mentioning

confidence: 58%

“…Using data provided in the report 1 and by Dr Kennedy, we have calculated the gentamicin AUC at day 7 when a dose of 10 mg/kg per 24 h was given 12‐hourly resulting in a trough level of 1.2 mg/L and at which time the serum creatinine was 80 μmol/L. The calculated AUC is almost twice the recommended target 6,8,9 and the elimination half‐life approaching 3 h, which suggests impaired tobramycin clearance. Since this trough gentamicin level was considered ‘below the toxic range’, the above dosing regimen was continued for a further 7 days at which time the trough gentamicin was 5.6 mg/L and the serum creatinine was 136 μmol/L and continued to rise thereafter.…”

mentioning

confidence: 99%

See 2 more Smart Citations

Re: Antibiotic Renal Failure and Cystic Fibrosis

Coulthard

Smith

Martin

2006

J Paediatrics Child Health

View full text Add to dashboard Cite

supporting

confidence: 74%

mentioning

confidence: 58%

mentioning

confidence: 99%

See 1 more Smart Citation

Re: Antibiotic Renal Failure and Cystic Fibrosis

Coulthard

Smith

Martin

2006

J Paediatrics Child Health

View full text Add to dashboard Cite

“…Therapeutic drug monitoring of serum aminoglycoside concentrations is imperative to optimize clinical outcomes and minimize the risk of toxicity. [51][52][53] Little data are available that suggest the most appropriate method for monitoring EID of aminoglycosides in patients with cystic fibrosis. Although its usefulness is not fully accepted, a single-concentration method is commonly used in the general adult population.…”

Section: Therapeutic Drug Monitoringmentioning

confidence: 99%

Extended‐Interval Once‐Daily Dosing of Aminoglycosides in Adult and Pediatric Patients with Cystic Fibrosis

Prescott

Nagel²

2010

Pharmacotherapy

View full text Add to dashboard Cite

Extended-interval once-daily dosing with the aminoglycoside tobramycin has been proven to be equally efficacious as traditional thrice-daily dosing for treatment of the pulmonary exacerbations of cystic fibrosis in adults and children older than 5 years. The frequencies of acute ototoxicity and nephrotoxicity do not appear to be significantly different between patients treated with once- versus thrice-daily dosing, and the risk of acute nephrotoxicity may actually be lower in pediatric patients when once-daily dosing is used. Long-term studies are needed to fully assess the impact that cumulative treatments with once-daily dosing have on renal and auditory function. An increase in antimicrobial resistance has been suggested with once-daily dosing in the cystic fibrosis population. The extended-interval aminoglycoside dose should be determined based on previous therapeutic drug monitoring. If the patient is aminoglycoside (tobramycin) naïve, a dose of 10 mg/kg once/day is suggested, with the dose adjusted by using therapeutic drug monitoring to individualize therapy.

show abstract

“…The pharmacokinetics of aminoglycosides in patients with CF has been evaluated extensively [33][34][35][36][37][38][39][40][41][42][43][44]. The volume of distribution per kg body weight is often increased, and the elimination half-life is decreased [40].…”

Section: Pharmacokineticsmentioning

confidence: 99%

Aminoglycoside therapy against Pseudomonas aeruginosa in cystic fibrosis: A review

Ratjen

Brockhaus

Angyalosi

2009

Journal of Cystic Fibrosis

View full text Add to dashboard Cite

In patients with cystic fibrosis (CF), respiratory infections with the opportunistic bacterial pathogen Pseudomonas aeruginosa have a major impact on morbidity and mortality. Aminoglycosides, especially tobramycin, have been used successfully to combat these infections. Aminoglycoside penetration of bronchial secretions is poor when the antibiotic is administered intravenously. Nebulization allows direct delivery of the drug to the sites of infection within the airways, while avoiding systemic exposure. Published clinical data show that inhaled tobramycin reduces the bacterial load, improves lung function and reduces the number of hospital admissions. Inhaled tobramycin has been used successfully to eradicate P. aeruginosa in patients with early infection. Maintaining clinical benefits requires chronic tobramycin treatment, and the concept of chronic intermittent inhaled treatment (typically, alternating drug and drug-free periods of 28 days) was introduced to minimize the emergence of aminoglycoside resistant P. aeruginosa strains. Other therapeutic advances include the development of different tobramycin formulations and nebulizers that reduce delivery time without compromising efficacy. An optimal treatment regimen for patients with CF with early or intermittent P. aeruginosa infections remains a high priority to maintain long-term lung health.

show abstract

Therapeutic drug monitoring of once daily tobramycin in cystic fibrosis—caution with trough concentrations

Abstract: : The TDM approach of a trough <1 mg/L, as used with conventional 8-hourly tobramycin dosing, is not relevant to ODD.

Cited by 45 publications

References 30 publications

Re: Antibiotic Renal Failure and Cystic Fibrosis

Re: Antibiotic Renal Failure and Cystic Fibrosis

Extended‐Interval Once‐Daily Dosing of Aminoglycosides in Adult and Pediatric Patients with Cystic Fibrosis

Aminoglycoside therapy against Pseudomonas aeruginosa in cystic fibrosis: A review

Contact Info

Product

Resources

About