title: Toxic serum trough concentrations after administration of nebulized tobramycin.
abstract: The goal of administering nebulized antibiotics is to provide patients with a high concentration of drug at the infection site with minimal systemic effects. In two studies in which nebulized tobramycin 300 mg twice/day was administered, systemic peak concentrations were below 0.2 and 3.62 microg/ml, and trough concentrations were undetectable, making toxicity from this route of administration negligible. A 19-year-old woman who received a heart transplant was administered tobramycin inhalation solution for Acinetobacter baumanii pneumonia; her serum trough concentrations were found to be toxic (> 2.0 microg/ml). Her risk factors for experiencing these toxic concentrations were renal failure and administration of the drug by positive pressure ventilation. Although nebulized tobramycin is safe under routine circumstances, clinicians must be aware of its potential for toxicity in patients with renal dysfunction or in those receiving positive pressure ventilation.
authors.affiliation: Department of Pharmacy, Shands Hospital, University of Florida, 1600 Southwest Archer Road, Box 100316, Gainesville, FL 32610, USA. kahleda@shands.ufl.edu
authors.forename: Deborah A
authors.initials: DA
authors.lastname: Kahler
authors.forename: Kenneth O
authors.initials: KO
authors.lastname: Schowengerdt
authors.forename: F Jay
authors.initials: FJ
authors.lastname: Fricker
authors.forename: Melissa
authors.initials: M
authors.lastname: Mansfield
authors.forename: Gary A
authors.initials: GA
authors.lastname: Visner
authors.forename: Albert
authors.initials: A
authors.lastname: Faro
mesh_terms: D000280:Administration, Inhalation; D000328:Adult; D005260:Female; D006801:Humans; D009330:Nebulizers and Vaporizers; D014031:Tobramycin / Q000008:administration & dosage / Q000009:adverse effects* / Q000097:blood*
chemical_list: D014031:Tobramycin