Serum Concentrations of Aerosolized Tobramycin in Medical, Surgical, and Trauma Patients

Document Type

Letter to the Editor

Publication Date



Combination antibiotic therapy is often indicated for health care-associated pneumonia due to resistant pathogens and is recommended in the Infectious Diseases Society of America/American Thoracic Society guidelines on the management of community-acquired pneumonia and health care-associated pneumonia (1, 4). Antibiotic aerosolization enhances delivery to the lower respiratory tract while theoretically limiting toxicity. Aerosolized tobramycin (TOBI) is currently approved for use only in patients with cystic fibrosis (CF). According to the manufacturer (2007 tobramycin inhalation solution USP prescribing information, Novartis Pharmaceuticals, East Hanover, NJ), patients with normal renal function do not require routine tobramycin concentration monitoring. However, there is limited evidence of the safety of the use of TOBI in the non-CF population. Brown et al. found TOBI to be safe and to result in a microbiologic cure, but clinical outcomes did not differ from those achieved with systemic therapy (2). Systemic absorption of 40 mg TOBI every 8 h resulted in detectable levels but did not affect renal function. In our safety study, we postulated that non-CF patients would have similar serum tobramycin concentrations and that patients with normal renal function would not have tobramycin-associated renal insufficiency.