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Inhaled Tobramycin Usage in Critically Ill Pediatric Patients Without Cystic Fibrosis: A Pediatric
Peter N Johnson1, Dominique L Ropp2, Courtney Ranallo3
1Department of Pharmacy (JLM, SBN, PNJ), Clinical and Administrative Sciences, College of Pharmacy, University of Oklahoma Health Sciences Center, Oklahoma City, OK.
Objective:
The purpose of this study was to characterize reported usage, dosage regimens, and monitoring practices of inhaled tobramycin in health systems with neonatal intensive care units (NICUs), pediatric intensive care units (PICUs), and cardiovascular intensive care units (CICUs) from the members of the Pediatric Pharmacy Association (PPA). The primary objective was to identify the number of respondents who use an inhaled tobramycin protocol. The secondary objectives included the main indications, dosage regimens, monitoring parameters used, and administration details for inhaled tobramycin.
Methods:
A cross-sectional questionnaire was distributed to PPA members from March 28-May 22, 2023. Descriptive statistics were employed.
Results:
The questionnaire was completed by respondents at 79 institutions; respondents at 61 institutions used inhaled tobramycin in PICUs (n = 45; 73.8%), NICUs (n = 36; 59.0%), and CICUs (n = 14; 23.0%). Most respondents (n = 73; 92.4%) in the 61 institutions that use inhaled tobramycin did not have an established protocol. The most common tobramycin product used was a tobramycin nebulization solution, and the most common indication was ventilator-associated tracheitis. Respondents noted the most common dosage regimen was 40 to 80 mg every 8 to 12 hours or 150 mg every 12 hours, regardless of patient age. Most respondents were unaware of the nebulizer used and the location of the nebulizer within the ventilator circuit. Additionally, the respondents noted that their intensive care units do not routinely check tobramycin serum concentrations.
Conclusion:
Most respondents did not have a standardized inhaled tobramycin protocol. There are variations in the dosage regimen, administration, and monitoring practices in critically ill children receiving inhaled tobramycin. Pediatric clinical pharmacists should work with interprofessional teams, including respiratory therapists and providers, to standardize the use of inhaled antibiotics.
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