Extended-interval once-daily dosing of aminoglycosides in adult and pediatric patients with cystic fibrosis.
Extended-interval once-daily dosing with the aminoglycoside tobramycin has been proven to be equally efficacious as traditional thrice-daily dosing for treatment of the pulmonary exacerbations of cystic fibrosis in adults and children older than 5 years. The frequencies of acute ototoxicity and nephrotoxicity do not appear to be significantly different between patients treated with once- versus thrice-daily dosing, and the risk of acute nephrotoxicity may actually be lower in pediatric patients when once-daily dosing is used. Long-term studies are needed to fully assess the impact that cumulative treatments with once-daily dosing have on renal and auditory function. An increase in antimicrobial resistance has been suggested with once-daily dosing in the cystic fibrosis population. The extended-interval aminoglycoside dose should be determined based on previous therapeutic drug monitoring. If the patient is aminoglycoside (tobramycin) naïve, a dose of 10 mg/kg once/day is suggested, with the dose adjusted by using therapeutic drug monitoring to individualize therapy.
Prescott
William A
WA
University at Buffalo School of Pharmacy and Pharmaceutical Sciences, New York 14260, USA. prescott@buffalo.edu
Nagel
Jerod L
JL
D000293:Adolescent; D000328:Adult; D000368:Aged; D000617:Aminoglycosides / Q000008:administration & dosage / Q000009:adverse effects / Q000493:pharmacokinetics / Q000627:therapeutic use*; D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000009:adverse effects / Q000493:pharmacokinetics / Q000627:therapeutic use*; D002648:Child; D002986:Clinical Trials as Topic; D003550:Cystic Fibrosis / Q000150:complications*; D004334:Drug Administration Schedule; D016903:Drug Monitoring; D006801:Humans; D008875:Middle Aged; D012141:Respiratory Tract Infections / Q000150:complications / Q000188:drug therapy*; D014031:Tobramycin / Q000008:administration & dosage / Q000009:adverse effects / Q000493:pharmacokinetics / Q000627:therapeutic use; D016896:Treatment Outcome; D055815:Young Adult
D000617:Aminoglycosides; D000900:Anti-Bacterial Agents; D014031:Tobramycin