A review of tobramycin levels in paediatric cystic fibrosis patients

C.A. Langley, M.C. Nock, L.E. Paskin, M. Desai

Research output: Contribution to journalMeeting abstract

Abstract

Introduction Cystic fibrosis is a common recessive disorder primarily affecting the lungs and often resulting in pulmonary infection by Pseudomonas aeruginosa. Tobramycin is currently used to prevent the growth of Pseudomonas aeruginosa; however, it has a narrow therapeutic index and requires extensive monitoring. The aim of this study was to review the current practice in administration and monitoring of once daily tobramycin in paediatric cystic fibrosis patients at Birmingham Children’s Hospital (BCH).
Materials & Methods Design: Analysis of forty-nine once daily tobramycin courses in fifteen patients (five male; ten female) during 2010. Setting: Birmingham Children’s Hospital, UK. Main outcome measures: Patient height and weight, dosage and time of administration, drug plasma levels, urea and electrolyte levels.
Results: Once daily tobramycin was administered at a mean dose of 9.94 mg/kg (n = 49, range 8.8–11.0 mg/kg) which is consistent with current BCH guidelines. At least one trough level was observed for every course (mean = 1.33; n = 49). Trough levels greater than 1 mg/L were found in 17% (n = 11/65) of samples. Tobramycin was administered between 15:00 and 21:00 in 75% (n = 30/40) of courses, with a further 23% (n = 9/40) of courses being administered after 21:00. Only 39% (n = 19/49) of courses had urea and electrolyte levels monitored conflicting with current practice elsewhere in the UK. Furthermore, no patients underwent any routine monitoring for ototoxicity.
Discussions, Conclusion: The use and associated monitoring of once daily tobramycin varies within the UK. Current practice at BCH with regard to the dosing of once daily tobramycin and the timing of the first trough level are consistent with available guidelines. However an increase in the frequency of renal monitoring is recommended considering national practice as urea and creatinine levels should be taken at least once within a fourteen day course. Furthermore, a proportion of courses were administered after 21:00 which, due to a decrease in glomerular filtration rate, may result in an increased risk of toxic effects.
Disclosure of Interest: None Declared
Original languageEnglish
Article numberPT-042
Pages (from-to)250
Number of pages1
JournalInternational Journal of Clinical Pharmacy
Volume34
Issue number1
Early online date8 Jan 2012
Publication statusPublished - Feb 2012
EventESCP 40th International Symposium on Clinical Pharmacy: Clinical pharmacy: connecting care and outcomes - Dublin, Ireland
Duration: 19 Oct 201121 Oct 2011

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Tobramycin
Pediatrics
Cystic Fibrosis
Monitoring
Urea
Pseudomonas aeruginosa
Electrolytes
Guidelines
Lung
Poisons
Disclosure
Glomerular Filtration Rate
Creatinine
Outcome Assessment (Health Care)
Kidney
Plasmas
Weights and Measures
Growth
Infection
Pharmaceutical Preparations

Bibliographical note

Abstracts

Cite this

Langley, C.A. ; Nock, M.C. ; Paskin, L.E. ; Desai, M. / A review of tobramycin levels in paediatric cystic fibrosis patients. In: International Journal of Clinical Pharmacy. 2012 ; Vol. 34, No. 1. pp. 250.
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abstract = "Introduction Cystic fibrosis is a common recessive disorder primarily affecting the lungs and often resulting in pulmonary infection by Pseudomonas aeruginosa. Tobramycin is currently used to prevent the growth of Pseudomonas aeruginosa; however, it has a narrow therapeutic index and requires extensive monitoring. The aim of this study was to review the current practice in administration and monitoring of once daily tobramycin in paediatric cystic fibrosis patients at Birmingham Children’s Hospital (BCH). Materials & Methods Design: Analysis of forty-nine once daily tobramycin courses in fifteen patients (five male; ten female) during 2010. Setting: Birmingham Children’s Hospital, UK. Main outcome measures: Patient height and weight, dosage and time of administration, drug plasma levels, urea and electrolyte levels.Results: Once daily tobramycin was administered at a mean dose of 9.94 mg/kg (n = 49, range 8.8–11.0 mg/kg) which is consistent with current BCH guidelines. At least one trough level was observed for every course (mean = 1.33; n = 49). Trough levels greater than 1 mg/L were found in 17{\%} (n = 11/65) of samples. Tobramycin was administered between 15:00 and 21:00 in 75{\%} (n = 30/40) of courses, with a further 23{\%} (n = 9/40) of courses being administered after 21:00. Only 39{\%} (n = 19/49) of courses had urea and electrolyte levels monitored conflicting with current practice elsewhere in the UK. Furthermore, no patients underwent any routine monitoring for ototoxicity. Discussions, Conclusion: The use and associated monitoring of once daily tobramycin varies within the UK. Current practice at BCH with regard to the dosing of once daily tobramycin and the timing of the first trough level are consistent with available guidelines. However an increase in the frequency of renal monitoring is recommended considering national practice as urea and creatinine levels should be taken at least once within a fourteen day course. Furthermore, a proportion of courses were administered after 21:00 which, due to a decrease in glomerular filtration rate, may result in an increased risk of toxic effects.Disclosure of Interest: None Declared",
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A review of tobramycin levels in paediatric cystic fibrosis patients. / Langley, C.A.; Nock, M.C.; Paskin, L.E.; Desai, M.

In: International Journal of Clinical Pharmacy, Vol. 34, No. 1, PT-042, 02.2012, p. 250.

Research output: Contribution to journalMeeting abstract

TY - JOUR

T1 - A review of tobramycin levels in paediatric cystic fibrosis patients

AU - Langley, C.A.

AU - Nock, M.C.

AU - Paskin, L.E.

AU - Desai, M.

N1 - Abstracts

PY - 2012/2

Y1 - 2012/2

N2 - Introduction Cystic fibrosis is a common recessive disorder primarily affecting the lungs and often resulting in pulmonary infection by Pseudomonas aeruginosa. Tobramycin is currently used to prevent the growth of Pseudomonas aeruginosa; however, it has a narrow therapeutic index and requires extensive monitoring. The aim of this study was to review the current practice in administration and monitoring of once daily tobramycin in paediatric cystic fibrosis patients at Birmingham Children’s Hospital (BCH). Materials & Methods Design: Analysis of forty-nine once daily tobramycin courses in fifteen patients (five male; ten female) during 2010. Setting: Birmingham Children’s Hospital, UK. Main outcome measures: Patient height and weight, dosage and time of administration, drug plasma levels, urea and electrolyte levels.Results: Once daily tobramycin was administered at a mean dose of 9.94 mg/kg (n = 49, range 8.8–11.0 mg/kg) which is consistent with current BCH guidelines. At least one trough level was observed for every course (mean = 1.33; n = 49). Trough levels greater than 1 mg/L were found in 17% (n = 11/65) of samples. Tobramycin was administered between 15:00 and 21:00 in 75% (n = 30/40) of courses, with a further 23% (n = 9/40) of courses being administered after 21:00. Only 39% (n = 19/49) of courses had urea and electrolyte levels monitored conflicting with current practice elsewhere in the UK. Furthermore, no patients underwent any routine monitoring for ototoxicity. Discussions, Conclusion: The use and associated monitoring of once daily tobramycin varies within the UK. Current practice at BCH with regard to the dosing of once daily tobramycin and the timing of the first trough level are consistent with available guidelines. However an increase in the frequency of renal monitoring is recommended considering national practice as urea and creatinine levels should be taken at least once within a fourteen day course. Furthermore, a proportion of courses were administered after 21:00 which, due to a decrease in glomerular filtration rate, may result in an increased risk of toxic effects.Disclosure of Interest: None Declared

AB - Introduction Cystic fibrosis is a common recessive disorder primarily affecting the lungs and often resulting in pulmonary infection by Pseudomonas aeruginosa. Tobramycin is currently used to prevent the growth of Pseudomonas aeruginosa; however, it has a narrow therapeutic index and requires extensive monitoring. The aim of this study was to review the current practice in administration and monitoring of once daily tobramycin in paediatric cystic fibrosis patients at Birmingham Children’s Hospital (BCH). Materials & Methods Design: Analysis of forty-nine once daily tobramycin courses in fifteen patients (five male; ten female) during 2010. Setting: Birmingham Children’s Hospital, UK. Main outcome measures: Patient height and weight, dosage and time of administration, drug plasma levels, urea and electrolyte levels.Results: Once daily tobramycin was administered at a mean dose of 9.94 mg/kg (n = 49, range 8.8–11.0 mg/kg) which is consistent with current BCH guidelines. At least one trough level was observed for every course (mean = 1.33; n = 49). Trough levels greater than 1 mg/L were found in 17% (n = 11/65) of samples. Tobramycin was administered between 15:00 and 21:00 in 75% (n = 30/40) of courses, with a further 23% (n = 9/40) of courses being administered after 21:00. Only 39% (n = 19/49) of courses had urea and electrolyte levels monitored conflicting with current practice elsewhere in the UK. Furthermore, no patients underwent any routine monitoring for ototoxicity. Discussions, Conclusion: The use and associated monitoring of once daily tobramycin varies within the UK. Current practice at BCH with regard to the dosing of once daily tobramycin and the timing of the first trough level are consistent with available guidelines. However an increase in the frequency of renal monitoring is recommended considering national practice as urea and creatinine levels should be taken at least once within a fourteen day course. Furthermore, a proportion of courses were administered after 21:00 which, due to a decrease in glomerular filtration rate, may result in an increased risk of toxic effects.Disclosure of Interest: None Declared

UR - http://link.springer.com/article/10.1007%2Fs11096-011-9602-2

M3 - Meeting abstract

VL - 34

SP - 250

JO - International Journal of Clinical Pharmacy

JF - International Journal of Clinical Pharmacy

SN - 2210-7703

IS - 1

M1 - PT-042

ER -