{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,20]],"date-time":"2026-10-20T07:50:26Z","timestamp":1792482626045,"version":"4.5.0"},"reference-count":22,"publisher":"The Pediatric Pharmacy Association","issue":"1","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2023]]},"abstract":"<jats:sec>\n          <jats:title>OBJECTIVE<\/jats:title>\n          <jats:p>An institution's tobramycin pharmacokinetics (PK) database was reviewed to evaluate the efficacy and safety of empiric tobramycin dosing and monitoring strategies used in pediatric patients with cystic fibrosis (CF). The relationship between patient age and tobramycin dosing needed to achieve the area under the curve (AUC) goal was investigated.<\/jats:p>\n        <\/jats:sec>\n        <jats:sec>\n          <jats:title>METHODS<\/jats:title>\n          <jats:p>Retrospective chart review was performed for patients who received tobramycin during a CF exacerbation from 2009 to 2019 who received PK monitoring by pediatric pharmacists. Tobramycin dosing needed to achieve an AUC of 100 mg\u00b7hr\/L was calculated for each patient. Serum creatinine and concomitant nephrotoxin use were collected as surrogate nephrotoxicity endpoints to evaluate safety.<\/jats:p>\n        <\/jats:sec>\n        <jats:sec>\n          <jats:title>RESULTS<\/jats:title>\n          <jats:p>Goal AUC (100 \u00b1 15 mg\u00b7hr\/L) was achieved based on initial or repeat PK calculations in 43.5% (95% CI, 37.7\u201349.3) of 85 unique patients across 326 encounters. Patients with calculated recommended doses of 9.5 to 11.9 mg\/kg every 24 hours empirically achieved goal AUC in 77% (78\/101) of encounters. The odds of achieving goal AUC were 56% higher for children aged 10 vs 5 years (OR = 1.56; 95% CI, 1.04\u20132.34; p = 0.033) and 32% higher for children aged 15 vs 10 years (OR = 1.32; 95% CI, 1.07\u20131.61; p = 0.008). Overall rates of acute kidney injury and concomitant nephrotoxin use were 10.8% (95% CI, 6.2\u201315.5) and 80.7% (95% CI, 74.3\u201387.1), respectively.<\/jats:p>\n        <\/jats:sec>\n        <jats:sec>\n          <jats:title>CONCLUSIONS<\/jats:title>\n          <jats:p>Desired AUC was achieved by 43.5% of pediatric patients with CF using tobramycin 10 mg\/kg every 24 hours. Older patient age was associated with higher initial AUC attainment and fewer dose modifications. Younger children may require higher weight-based dosing to meet AUC goals.<\/jats:p>\n        <\/jats:sec>","DOI":"10.5863\/1551-6776-28.1.63","type":"journal-article","created":{"date-parts":[[2023,2,2]],"date-time":"2023-02-02T20:48:55Z","timestamp":1675370935000},"page":"63-70","source":"Crossref","is-referenced-by-count":4,"title":["Review of Tobramycin Dosing in Pediatric Patients With Cystic Fibrosis"],"prefix":"10.5863","volume":"28","author":[{"given":"Taylor A.","family":"Imburgia","sequence":"first","affiliation":[{"name":"Department of Pharmacy (TAI, RMS, HC, MCB), American Family Children's Hospital at University of Wisconsin Health, Madison, WI"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ryan M.","family":"Seagren","sequence":"additional","affiliation":[{"name":"Department of Pharmacy (TAI, RMS, HC, MCB), American Family Children's Hospital at University of Wisconsin Health, Madison, WI"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hanna","family":"Christensen","sequence":"additional","affiliation":[{"name":"Department of Pharmacy (TAI, RMS, HC, MCB), American Family Children's Hospital at University of Wisconsin Health, Madison, WI"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael R.","family":"Lasarev","sequence":"additional","affiliation":[{"name":"Department of Biostatistics and Medical Informatics (MRL), University of Wisconsin\u2013Madison, Madison, WI"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Monica C.","family":"Bogenschutz","sequence":"additional","affiliation":[{"name":"Department of Pharmacy (TAI, RMS, HC, MCB), American Family Children's Hospital at University of Wisconsin Health, Madison, WI"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"3883","reference":[{"issue":"6","key":"i2331-348X-28-1-63-b1","series-title":"J Pediatr Health Car","first-page":"565","article-title":"Infectious diseases pharmacotherapy for children with cystic fibrosis","volume":"29","year":"2015","unstructured":"Molloy\n              L,\n            \n            \n              Nichols\n              K.\n            \n          \n          Infectious diseases pharmacotherapy for children with cystic fibrosis.\n\t\t\t\t\tJ Pediatr Health Car.\n\t\t\t\t\t2015;\n\t\t\t\t\t29(\n\t\t\t\t\t6):\n\t\t\t\t\t565\u2013\n\t\t\t\t\t578."},{"key":"i2331-348X-28-1-63-b2","article-title":"Vertex Pharmaceuticals Incorporated. Understanding the early, systemic progression of cystic fibrosis (CF): a resource for the CF Center Care Team. Accessed August 24, 2019","unstructured":"Vertex Pharmaceuticals Incorporated. Understanding the early, systemic progression of cystic fibrosis (CF): a resource for the CF Center Care Team. Accessed August 24, 2019.\n\t\t\t\t\thttps:\/\/www.cfsourcehcp.com\/files\/the_role_of_cftr_mutations_in_causing_cystic_fibrosis.pdf"},{"key":"i2331-348X-28-1-63-b3","article-title":"Cystic Fibrosis Foundation. Patient registry annual data report 2017","unstructured":"Cystic Fibrosis Foundation. Patient registry annual data report 2017.\n\t\t\t\t\tAccessed August 24, 2019. https:\/\/www.cff.org\/Research\/Researcher-Resources\/Patient-Registry\/2017-Patient-Registry-Annual-Data-Report.pdf"},{"issue":"9","key":"i2331-348X-28-1-63-b4","series-title":"Am J Respir Crit Care Med","first-page":"802","article-title":"Cystic fibrosis pulmonary guidelines: treatment of pulmonary exacerbations","volume":"180","year":"2009","unstructured":"Flume\n              PA,\n            \n            \n              Mogayzel\n              PK\n              Jr,\n            \n            \n              Robinson\n              KA,\n            \n          \n          .\n\t\t\t\t\tCystic fibrosis pulmonary guidelines: treatment of pulmonary exacerbations.\n\t\t\t\t\tAm J Respir Crit Care Med.\n\t\t\t\t\t2009;\n\t\t\t\t\t180(\n\t\t\t\t\t9):\n\t\t\t\t\t802\u2013\n\t\t\t\t\t808."},{"issue":"11","key":"i2331-348X-28-1-63-b5","series-title":"Pharmacotherapy","first-page":"1252","article-title":"Pharmacodynamic characterization of nephrotoxicity associated with once-daily aminoglycoside","volume":"19","year":"1999","unstructured":"Murray\n              KR,\n            \n            \n              McKinnon\n              PG,\n            \n            \n              Mitrzyk\n              B,\n            \n            \n              Rybak\n              MJ.\n            \n          \n          Pharmacodynamic characterization of nephrotoxicity associated with once-daily aminoglycoside.\n\t\t\t\t\tPharmacotherapy.\n\t\t\t\t\t1999;\n\t\t\t\t\t19(\n\t\t\t\t\t11):\n\t\t\t\t\t1252\u2013\n\t\t\t\t\t1260."},{"issue":"6","key":"i2331-348X-28-1-63-b6","series-title":"Thorax","first-page":"532","article-title":"Case-control study of acute renal failure in patients with cystic fibrosis in the UK","volume":"63","year":"2008","unstructured":"Smyth\n              A,\n            \n            \n              Lewis\n              S,\n            \n            \n              Bertenshaw\n              C,\n            \n          \n          .\n\t\t\t\t\tCase-control study of acute renal failure in patients with cystic fibrosis in the UK.\n\t\t\t\t\tThorax.\n\t\t\t\t\t2008;\n\t\t\t\t\t63(\n\t\t\t\t\t6):\n\t\t\t\t\t532\u2013\n\t\t\t\t\t535."},{"issue":"4","key":"i2331-348X-28-1-63-b7","series-title":"J Pediatr Pharmacol Ther","first-page":"262","article-title":"National survey of extended-interval aminoglycoside dosing in pediatric cystic fibrosis pulmonary exacerbations","volume":"16","year":"2011","unstructured":"Prescott\n              WA.\n            \n          \n          National survey of extended-interval aminoglycoside dosing in pediatric cystic fibrosis pulmonary exacerbations.\n\t\t\t\t\tJ Pediatr Pharmacol Ther.\n\t\t\t\t\t2011;\n\t\t\t\t\t16(\n\t\t\t\t\t4):\n\t\t\t\t\t262\u2013\n\t\t\t\t\t269."},{"issue":"3","key":"i2331-348X-28-1-63-b8","series-title":"Kidney Int","first-page":"580","article-title":"A prospective multi-center quality improvement initiative (NINJA) indicates a reduction in nephrotoxic acute kidney injury in hospitalized children","volume":"97","year":"2020","unstructured":"Goldstein\n              SL,\n            \n            \n              Dahale\n              D,\n            \n            \n              Kirkendall\n              ES.\n            \n          \n          A prospective multi-center quality improvement initiative (NINJA) indicates a reduction in nephrotoxic acute kidney injury in hospitalized children.\n\t\t\t\t\tKidney Int.\n\t\t\t\t\t2020;\n\t\t\t\t\t97(\n\t\t\t\t\t3):\n\t\t\t\t\t580\u2013\n\t\t\t\t\t588."},{"key":"i2331-348X-28-1-63-b9","series-title":"Generalizing Estimating Equations","year":"2003","unstructured":"Hardin\n              JW,\n            \n            \n              Hilbe\n              JM.\n            \n          \n          \n            Generalizing Estimating Equations\n          .\n\t\t\t\t\tBoca Raton, FL:\n\t\t\t\t\tChapman & Hall\/CRC;\n\t\t\t\t\t2003."},{"issue":"1","key":"i2331-348X-28-1-63-b10","series-title":"Biometrika","first-page":"13","article-title":"Longitudinal data analysis using generalized linear models","volume":"73","year":"1986","unstructured":"Liang\n              k-Y,\n            \n            \n              Zeger\n              SL.\n            \n          \n          Longitudinal data analysis using generalized linear models.\n\t\t\t\t\tBiometrika.\n\t\t\t\t\t1986;\n\t\t\t\t\t73(\n\t\t\t\t\t1):\n\t\t\t\t\t13\u2013\n\t\t\t\t\t22."},{"key":"i2331-348X-28-1-63-b11","series-title":"Statistical Modeling in GLIM4","first-page":"123","year":"2005","unstructured":"Aitkin\n              M,\n            \n            \n              Francis\n              B,\n            \n            \n              Hinde\n              J.\n            \n          \n          \n            Statistical Modeling in GLIM4\n          .\n\t\t\t\t\t2nd ed.\n\t\t\t\t\tNew York, NY:\n\t\t\t\t\tOxford University Press;\n\t\t\t\t\t2005:\n\t\t\t\t\t123\u2013\n\t\t\t\t\t124."},{"issue":"9459","key":"i2331-348X-28-1-63-b12","series-title":"Lancet","first-page":"573","article-title":"Once versus three-times daily regimens of tobramycin treatment for pulmonary exacerbations of cystic fibrosis\u2013the TOPIC study: a randomized controlled trial","volume":"365","year":"2005","unstructured":"Smyth\n              A,\n            \n            \n              Tan\n              KH,\n            \n            \n              Hyman-Taylor\n              P,\n            \n          \n          .\n\t\t\t\t\tOnce versus three-times daily regimens of tobramycin treatment for pulmonary exacerbations of cystic fibrosis\u2013the TOPIC study: a randomized controlled trial.\n\t\t\t\t\tLancet.\n\t\t\t\t\t2005;\n\t\t\t\t\t365(\n\t\t\t\t\t9459):\n\t\t\t\t\t573\u2013\n\t\t\t\t\t578."},{"issue":"2","key":"i2331-348X-28-1-63-b13","series-title":"J Pediatr Pharmacol Ther","first-page":"152","article-title":"Safety of extended interval tobramycin in cystic fibrosis patients less than 6 years old","volume":"23","year":"2018","unstructured":"Arends\n              A,\n            \n            \n              Pettit\n              R.\n            \n          \n          Safety of extended interval tobramycin in cystic fibrosis patients less than 6 years old.\n\t\t\t\t\tJ Pediatr Pharmacol Ther.\n\t\t\t\t\t2018;\n\t\t\t\t\t23(\n\t\t\t\t\t2):\n\t\t\t\t\t152\u2013\n\t\t\t\t\t158."},{"issue":"1","key":"i2331-348X-28-1-63-b14","series-title":"Pharmacotherapy","first-page":"95","article-title":"Extended-interval once-daily dosing of aminoglycosides in adult and pediatric patients with cystic fibrosis","volume":"30","year":"2010","unstructured":"Prescott\n              WA,\n            \n            \n              Nagel\n              JL.\n            \n          \n          Extended-interval once-daily dosing of aminoglycosides in adult and pediatric patients with cystic fibrosis.\n\t\t\t\t\tPharmacotherapy.\n\t\t\t\t\t2010;\n\t\t\t\t\t30(\n\t\t\t\t\t1):\n\t\t\t\t\t95\u2013\n\t\t\t\t\t108."},{"issue":"6","key":"i2331-348X-28-1-63-b15","series-title":"J Antimicrob Chemother","first-page":"1135","article-title":"Pharmacokinetic modelling of a once-daily dosing regimen for intravenous tobramycin in paediatric cystic fibrosis patients","volume":"59","year":"2007","unstructured":"Lam\n              W,\n            \n            \n              Tjon\n              J,\n            \n            \n              Seto\n              W,\n            \n          \n          .\n\t\t\t\t\tPharmacokinetic modelling of a once-daily dosing regimen for intravenous tobramycin in paediatric cystic fibrosis patients.\n\t\t\t\t\tJ Antimicrob Chemother.\n\t\t\t\t\t2007;\n\t\t\t\t\t59(\n\t\t\t\t\t6):\n\t\t\t\t\t1135\u2013\n\t\t\t\t\t1140."},{"issue":"4","key":"i2331-348X-28-1-63-b16","series-title":"Br J Clin Pharmacol","first-page":"502","article-title":"Target concentration intervention is needed for tobramycin dosing in paediatric patients with cystic fibrosis\u2013a population pharmacokinetic study","volume":"65","year":"2008","unstructured":"Henning\n              S,\n            \n            \n              Norris\n              R,\n            \n            \n              Kirkpatrick\n              CMJ.\n            \n          \n          Target concentration intervention is needed for tobramycin dosing in paediatric patients with cystic fibrosis\u2013a population pharmacokinetic study.\n\t\t\t\t\tBr J Clin Pharmacol.\n\t\t\t\t\t2008;\n\t\t\t\t\t65(\n\t\t\t\t\t4):\n\t\t\t\t\t502\u2013\n\t\t\t\t\t510."},{"issue":"11","key":"i2331-348X-28-1-63-b17","series-title":"Antimicrob Agents Chemother","first-page":"6698","article-title":"Bayesian estimation of tobramycin exposure in patients with cystic fibrosis","volume":"60","year":"2016","unstructured":"Barras\n              MA,\n            \n            \n              Serisier\n              D,\n            \n            \n              Henning\n              S,\n            \n          \n          .\n\t\t\t\t\tBayesian estimation of tobramycin exposure in patients with cystic fibrosis.\n\t\t\t\t\tAntimicrob Agents Chemother.\n\t\t\t\t\t2016;\n\t\t\t\t\t60(\n\t\t\t\t\t11):\n\t\t\t\t\t6698\u2013\n\t\t\t\t\t6702."},{"issue":"12","key":"i2331-348X-28-1-63-b18","series-title":"Pharmacotherapy","first-page":"1229","article-title":"Reappraisal of contemporary pharmacokinetic and pharmacodynamics principles for informing aminoglycoside dosing","volume":"38","year":"2018","unstructured":"Bland\n              CM,\n            \n            \n              Pai\n              MP,\n            \n            \n              Lodise\n              TP.\n            \n          \n          Reappraisal of contemporary pharmacokinetic and pharmacodynamics principles for informing aminoglycoside dosing.\n\t\t\t\t\tPharmacotherapy.\n\t\t\t\t\t2018;\n\t\t\t\t\t38(\n\t\t\t\t\t12):\n\t\t\t\t\t1229\u2013\n\t\t\t\t\t1238."},{"key":"i2331-348X-28-1-63-b19","series-title":"Br J Clin Pharmacol","first-page":"605","article-title":"A suggested approach to once-daily aminoglycoside dosing","volume":"39","year":"1995","unstructured":"Begg\n              EG,\n            \n            \n              Barclay\n              ML,\n            \n            \n              Duffull\n              SB.\n            \n          \n          A suggested approach to once-daily aminoglycoside dosing.\n\t\t\t\t\tBr J Clin Pharmacol.\n\t\t\t\t\t1995;\n\t\t\t\t\t39:\n\t\t\t\t\t605\u2013\n\t\t\t\t\t609."},{"issue":"2","key":"i2331-348X-28-1-63-b20","series-title":"J Cyst Fibros","first-page":"125","article-title":"Therapeutic drug monitoring of once daily tobramycin in cystic fibrosis\u2013caution with trough concentrations","volume":"6","year":"2007","unstructured":"Coulthard\n              KP,\n            \n            \n              Peckham\n              DG,\n            \n            \n              Conway\n              SP.\n            \n          \n          Therapeutic drug monitoring of once daily tobramycin in cystic fibrosis\u2013caution with trough concentrations.\n\t\t\t\t\tJ Cyst Fibros.\n\t\t\t\t\t2007;\n\t\t\t\t\t6(\n\t\t\t\t\t2):\n\t\t\t\t\t125\u2013\n\t\t\t\t\t130."},{"issue":"4","key":"i2331-348X-28-1-63-b21","series-title":"Antimicrob Agents Chemother","first-page":"809","article-title":"Pharmacokinetics of tobramycin in adults with cystic fibrosis: implications for once-daily administration","volume":"44","year":"2000","unstructured":"Beringer\n              PM,\n            \n            \n              Vinks\n              AA,\n            \n            \n              Jelliffe\n              RW,\n            \n            \n              Shapiro\n              BJ.\n            \n          \n          Pharmacokinetics of tobramycin in adults with cystic fibrosis: implications for once-daily administration.\n\t\t\t\t\tAntimicrob Agents Chemother.\n\t\t\t\t\t2000;\n\t\t\t\t\t44(\n\t\t\t\t\t4):\n\t\t\t\t\t809\u2013\n\t\t\t\t\t813."},{"issue":"11","key":"i2331-348X-28-1-63-b22","series-title":"Pediatric Pulmonol","first-page":"1047","article-title":"Optimization of anti-pseudomonal antibiotics for cystic fibrosis pulmonary exacerbations: v. aminoglycosides","volume":"48","year":"2013","unstructured":"Young\n              DC,\n            \n            \n              Zobell\n              JT,\n            \n            Stockmann,\n          \n          .\n\t\t\t\t\tOptimization of anti-pseudomonal antibiotics for cystic fibrosis pulmonary exacerbations: v. aminoglycosides.\n\t\t\t\t\tPediatric Pulmonol.\n\t\t\t\t\t2013;\n\t\t\t\t\t48(\n\t\t\t\t\t11):\n\t\t\t\t\t1047\u2013\n\t\t\t\t\t1061."}],"container-title":["The Journal of Pediatric Pharmacology and 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