Related Experiment Video
Updated: Jun 11, 2025
Multiplex Therapeutic Drug Monitoring by Isotope-dilution HPLC-MS/MS of Antibiotics in Critical Illnesses
Published on: August 30, 2018
Detectable Concentrations With Inhaled Tobramycin in Critically Ill Infants and Children Following Implementation of
Peter N Johnson1, Eugenie Chang2, Emily Cormack3
1Department of Pharmacy, Clinical and Administrative Sciences, College of Pharmacy, The University of Oklahoma, Oklahoma City, OK, USA.
Insights
Inhaled tobramycin in mechanically ventilated children frequently achieved therapeutic levels, but acute kidney injury (AKI) occurred in about one-fourth of cases. Trough monitoring is recommended for critically ill children receiving this treatment.
Area of Science:
- Pediatric Critical Care Medicine
- Pharmacokinetics and Drug Monitoring
- Infectious Diseases
Background:
- A protocol for inhaled tobramycin was established for mechanically ventilated children to treat ventilator-associated tracheitis or pneumonia.
- The method involved vibrating mesh nebulization of tobramycin 300 mg every 12 hours.
Purpose of the Study:
- To determine the incidence of detectable tobramycin trough concentrations (>0.5 µg/mL).
- To compare clinical characteristics between patients with and without detectable concentrations.
- To identify patients who developed acute kidney injury (AKI) using KDIGO criteria.
Main Methods:
- A single-center retrospective study included critically ill children (<18 years) without cystic fibrosis receiving inhaled tobramycin.
- Data collected included demographics, tobramycin regimen, and renal function.
- Statistical analysis used SAS 9.4, with multivariable regression to identify factors for detectable concentrations and AKI.
Main Results:
- Forty-four patients (66 courses) were analyzed; 68% had detectable tobramycin concentrations.
- Twenty-point-five percent of patients developed AKI.
- No significant differences in demographics or clinical factors were found between groups with or without detectable concentrations or AKI.
Conclusions:
- The majority of inhaled tobramycin courses in this population achieved detectable concentrations.
- AKI was associated with approximately one-fourth of the treatment courses.
- Trough monitoring of inhaled tobramycin is recommended for all mechanically ventilated critically ill children.
Background:
A protocol was established for ventilator-associated tracheitis or pneumonia using inhaled tobramycin 300 mg every 12 hours in mechanically ventilated children via a vibrating mesh nebulizer, 30 cm from the endotracheal tube in the inspiratory loop of the mechanical ventilator.
Objectives:
The primary objective was to determine the incidence of detectable tobramycin trough concentrations >0.5 µg/mL. Secondary objectives included a comparison of clinical characteristics between those with and without detectable concentrations and identification of patients with acute kidney injury (AKI) as defined by the Kidney Diseases Improving Global Outcomes (KDIGO) criteria.
Methods:
This was a single-center retrospective study of critically ill children <18 years without cystic fibrosis receiving inhaled tobramycin between July 1, 2016, and August 31, 2021. Data collection included demographics, tobramycin regimen, and renal function. Analysis was performed using SAS 9.4, with a P-value <0.05, and a multivariable regression model was performed to identify factors for detectable concentrations and AKI.
Results:
Forty-four patients (66 courses) were included, with an overall age of 0.83 years. Thirty (68%) patients had detectable concentrations and 9 (20.5%) developed AKI. No significant differences in demographics, diagnosis, mechanical ventilation settings, and number of nephrotoxins were noted between those with and without detectable concentrations or AKI. Multivariable regressions did not identify factors associated with detectable concentrations or AKI.
Conclusion And Relevance:
Detectable concentrations occurred with the majority of courses, with AKI associated with approximately one-fourth of courses. Clinicians should consider utilizing trough monitoring for all mechanically ventilated critically ill children receiving inhaled tobramycin.
