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Therapeutic drug monitoring of inhaled tobramycin in a patient with chronic kidney disease
  1. Rebeca Añez-Castaño1,
  2. Carles Iniesta-Navalón1,2,
  3. Miguel Almanchel-Rivadeneyra1,
  4. Eva García-Villalba3,
  5. Eva Oliver-Galera3,
  6. Lorena Rentero-Redondo1,2
    1. 1Department of Hospital Pharmacy, Reina Sofia University General Hospital, Murcia, Spain
    2. 2Clinical Pharmacokinetics and Applied Pharmacotherapy Group, Instituto Murciano de Investigación Biosanitaria (IMIB-Pascual Parrilla), El Palmar, Spain
    3. 3Department of Infectous Disease, Reina Sofia University General Hospital, Murcia, Spain
    1. Correspondence to Dr Carles Iniesta-Navalón; carles424{at}hotmail.com

    Abstract

    This case report investigates elevated serum concentrations of inhaled tobramycin in a patient with chronic kidney disease. The patient, a man in his early 80s with complex comorbidities, underwent tobramycin inhalation therapy for chronic respiratory infections caused by Pseudomonas aeruginosa. Despite the strategic localised treatment approach, unexpectedly high plasma tobramycin concentrations were observed. After a dosage adjustment guided by a pharmacokinetic-pharmacodynamic model, a final inhalation dose of 300 mg of tobramycin was determined at a 24-hour interval. This case report underscores the need for rigorous monitoring of plasma tobramycin levels in patients with renal impairment undergoing inhaled tobramycin therapy, advocating for enhanced pharmacokinetic models to improve the safety and efficacy of the treatment.

    • Pharmacokinetics
    • Kidney Failure, Chronic
    • Safety
    • Case Reports
    • Drug Monitoring

    Data availability statement

    All data relevant to the study are included in the article or uploaded as supplementary information.

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    Data availability statement

    All data relevant to the study are included in the article or uploaded as supplementary information.

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