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Updated: Aug 17, 2025

Dry Powder and Nebulized Aerosol Inhalation of Pharmaceuticals Delivered to Mice Using a Nose-only Exposure System
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Incidence and associated risk factors for systemic drug levels with inhaled aminoglycoside therapy

Jennifer M Schultheis1, Mary E Durham2, Shawn J Kram1

  • 1Department of Pharmacy, Duke University Hospital, Durham, NC, USA.

The Journal of Antimicrobial Chemotherapy
|December 13, 2022
PubMed
Abstract

Insights

Detecting inhaled aminoglycoside levels is crucial. Patients with cystic fibrosis, chronic kidney disease, lung transplants, or on mechanical ventilation have higher risks of detectable drug levels.

Area of Science:

  • Pharmacology and Therapeutics
  • Pulmonary Medicine
  • Nephrology

Background:

  • Inhaled aminoglycosides are vital for treating respiratory infections.
  • Monitoring drug levels is essential for optimizing therapy and minimizing toxicity.
  • Risk factors for detectable drug levels (DDLs) in this population require characterization.

Purpose of the Study:

  • To determine the incidence of DDLs in patients receiving inhaled aminoglycoside therapy.
  • To identify risk factors associated with achieving DDLs in this patient group.

Main Methods:

  • Retrospective, single-center study of adult inpatients receiving inhaled aminoglycosides.
  • Drug levels were analyzed, excluding those with recent IV aminoglycoside use or improper timing.
  • Logistic regression modeled associations between risk factors and DDLs.

Main Results:

  • 30.8% of 286 drug levels were detectable.
  • Cystic fibrosis (CF), chronic kidney disease (CKD), lung transplant, mechanical ventilation, and tobramycin use were linked to higher DDL odds.
  • No association found between DDLs and acute kidney injury.

Conclusions:

  • A significant proportion of inhaled aminoglycoside doses result in detectable drug levels.
  • Consider monitoring trough concentrations in patients with CF, CKD, lung transplant, mechanical ventilation, or on tobramycin.

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