Renal and vestibular toxicity due to inhaled tobramycin in a lung transplant recipient.
Chronic rejection is the major hurdle to long-term survival after lung transplantation. Endobronchial infection with Pseudomonas aeruginosa is common in patients with chronic rejection and this may further contribute to deterioration of the allograft. Inhaled tobramycin is commonly used to treat P aeruginosa airways infection in patients with cystic fibrosis. The safety of inhaled tobramycin in transplant recipients, however, has not been established. We describe the first report of a lung transplant recipient who developed renal failure and vestibular injury after receiving inhaled tobramycin. We review the literature regarding the safety of inhaled tobramycin and discuss potential mechanisms that may promote systemic toxicity in transplant recipients.
Ahya
Vivek N
VN
Pulmonary, Allergy, and Critical Care Division, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania 19104, USA. ahyav@mail.med.upenn.edu
Doyle
Alden M
AM
Mendez
James D
JD
Lipson
David A
DA
Christie
Jason D
JD
Blumberg
Emily A
EA
Pochettino
Alberto
A
Nelson
Linda
L
Bloom
Roy D
RD
Kotloff
Robert M
RM
D000280:Administration, Inhalation; D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000009:adverse effects*; D005260:Female; D006801:Humans; D016040:Lung Transplantation; D008875:Middle Aged; D011552:Pseudomonas Infections / Q000188:drug therapy* / Q000517:prevention & control*; D051437:Renal Insufficiency / Q000139:chemically induced* / Q000503:physiopathology; D014031:Tobramycin / Q000008:administration & dosage / Q000009:adverse effects*; D015837:Vestibular Diseases / Q000139:chemically induced* / Q000503:physiopathology
D000900:Anti-Bacterial Agents; D014031:Tobramycin