{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,11]],"date-time":"2026-06-11T23:23:09Z","timestamp":1781220189361,"version":"3.54.1"},"reference-count":26,"publisher":"Wiley","issue":"6","license":[{"start":{"date-parts":[[2016,5,28]],"date-time":"2016-05-28T00:00:00Z","timestamp":1464393600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["accpjournals.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Pharmacotherapy"],"published-print":{"date-parts":[[2016,6]]},"abstract":"<jats:sec><jats:title>Study Objective<\/jats:title><jats:p>To evaluate the success of an initial tobramycin dosing regimen to achieve target peak and trough concentrations in adult patients with pulmonary exacerbations of cystic fibrosis (<jats:styled-content style=\"fixed-case\">CF<\/jats:styled-content>).<\/jats:p><\/jats:sec><jats:sec><jats:title>Design<\/jats:title><jats:p>Retrospective single\u2010center medical record review.<\/jats:p><\/jats:sec><jats:sec><jats:title>Setting<\/jats:title><jats:p>Large tertiary care academic medical center.<\/jats:p><\/jats:sec><jats:sec><jats:title>Patients<\/jats:title><jats:p>A total of 186 patient encounters where 112 patients with <jats:styled-content style=\"fixed-case\">CF<\/jats:styled-content> were treated for acute pulmonary exacerbations with 10 mg\/kg\/day of tobramycin between January 1, 2009, and December 5, 2014.<\/jats:p><\/jats:sec><jats:sec><jats:title>Measurements and Main Results<\/jats:title><jats:p>Baseline demographics, clinical characteristics, tobramycin data, and pharmacokinetic variables were collected. The primary outcome evaluated the success of the initial tobramycin dosing regimen in attaining the target peak concentration. Secondary end points were achievement of the target trough concentration, achievement of combined peak and trough targets, and incidence of nephrotoxicity. Bivariate and multivariate analyses were performed to evaluate factors associated with achieving target concentrations. Of the 186 patient encounters, 41% achieved the target peak with the first dosing regimen, 62% achieved a target trough, and 23% achieved the target peak and trough. Nephrotoxicity occurred in 10% of patient encounters. A body mass index (<jats:styled-content style=\"fixed-case\">BMI<\/jats:styled-content>) of 18.5\u201324.9 kg\/m<jats:sup>2<\/jats:sup> was associated with higher odds of meeting the target peak compared with a <jats:styled-content style=\"fixed-case\">BMI<\/jats:styled-content> lower than 18.5 kg\/m<jats:sup>2<\/jats:sup> (odds ratio [<jats:styled-content style=\"fixed-case\">OR<\/jats:styled-content>] 24.5; 95% confidence interval [<jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content>] 5.2\u2013117.2). Conversely, a <jats:styled-content style=\"fixed-case\">BMI<\/jats:styled-content> of 18.5\u201324.9 kg\/m<jats:sup>2<\/jats:sup> was associated with lower odds of attaining the target trough compared with a <jats:styled-content style=\"fixed-case\">BMI<\/jats:styled-content> lower than 18.5 kg\/m<jats:sup>2<\/jats:sup> (<jats:styled-content style=\"fixed-case\">OR<\/jats:styled-content> 0.16; 95% <jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content> 0.05\u20130.56). Higher volume of distribution and elimination rate constants (K<jats:sub>el<\/jats:sub>) were associated with significantly lower odds of achieving the target peak. In addition, higher K<jats:sub>el<\/jats:sub> values were associated with significantly higher odds of achieving the target trough.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>The current initial tobramycin regimen did not achieve target serum tobramycin concentrations reliably. Optimization of the initial CF tobramycin dosing regimen is warranted.<\/jats:p><\/jats:sec>","DOI":"10.1002\/phar.1762","type":"journal-article","created":{"date-parts":[[2016,5,3]],"date-time":"2016-05-03T07:18:57Z","timestamp":1462259937000},"page":"623-630","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["Evaluation of a Once\/Day Tobramycin Regimen to Achieve Target Concentrations in Adult Patients with Cystic Fibrosis"],"prefix":"10.1002","volume":"36","author":[{"given":"Britta A.","family":"Staubes","sequence":"first","affiliation":[{"name":"Department of Pharmacy Ochsner Medical Center New Orleans Louisiana"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicole L.","family":"Metzger","sequence":"additional","affiliation":[{"name":"Department of Pharmacy Mercer University College of Pharmacy Atlanta Georgia"},{"name":"Department of Pharmaceutical Services Emory University Hospital Atlanta Georgia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Seth D.","family":"Walker","sequence":"additional","affiliation":[{"name":"Division of Pulmonology, Allergy, Critical Care, and Sleep Medicine Department of Medicine Emory University Atlanta Georgia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Samuel K.","family":"Peasah","sequence":"additional","affiliation":[{"name":"Department of Pharmacy Mercer University College of Pharmacy Atlanta Georgia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2016,5,28]]},"reference":[{"key":"e_1_2_7_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(05)17906-9"},{"key":"e_1_2_7_3_1","doi-asserted-by":"publisher","DOI":"10.1183\/09031936.02.00221602"},{"key":"e_1_2_7_4_1","doi-asserted-by":"publisher","DOI":"10.1093\/jac\/dkl328"},{"key":"e_1_2_7_5_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.312.7027.338"},{"key":"e_1_2_7_6_1","first-page":"67","article-title":"Evaluation of serum concentrations achieved with an empiric once\u2010daily tobramycin dosage regimen in children and adults with cystic fibrosis","volume":"17","author":"Vandenbussche HL","year":"2012","journal-title":"J Pediatr Pharmacol Ther"},{"key":"e_1_2_7_7_1","doi-asserted-by":"publisher","DOI":"10.2165\/00003088-200241100-00006"},{"key":"e_1_2_7_8_1","doi-asserted-by":"publisher","DOI":"10.1093\/infdis\/155.1.93"},{"key":"e_1_2_7_9_1","doi-asserted-by":"publisher","DOI":"10.1128\/AAC.43.3.623"},{"key":"e_1_2_7_10_1","doi-asserted-by":"publisher","DOI":"10.2165\/00003088-199936020-00001"},{"key":"e_1_2_7_11_1","doi-asserted-by":"publisher","DOI":"10.2165\/00003495-200161060-00001"},{"key":"e_1_2_7_12_1","doi-asserted-by":"publisher","DOI":"10.1164\/rccm.200812-1845PP"},{"key":"e_1_2_7_13_1","doi-asserted-by":"publisher","DOI":"10.1023\/A:1008634911114"},{"key":"e_1_2_7_14_1","doi-asserted-by":"publisher","DOI":"10.1128\/AAC.43.5.1003"},{"key":"e_1_2_7_15_1","doi-asserted-by":"publisher","DOI":"10.1186\/cc2872"},{"key":"e_1_2_7_16_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1600-6143.2004.00433.x"},{"key":"e_1_2_7_17_1","unstructured":"The European Committee on Antimicrobial Susceptibility Testing.Breakpoint Tables for Interpretation of MICs and Zone Diameters. 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