Phillips J A, Bell S C
Adult Cystic Fibrosis Unit, University of Queensland, Prince Charles Hospital, Brisbane, Australia.
Intern Med J. 2001 Jan-Feb;31(1):23-6. doi: 10.1046/j.1445-5994.2001.00010.x.
To determine the diversity of clinical practice with respect to aminoglycosides in cystic fibrosis (CF) units within Australia.
In April 1999, a questionnaire on the use of aminoglycosides was sent to 30 CF units across Australia. Information was collected about drug selection, dosing, monitoring and toxicity with intravenous administration.
Completed surveys were received from 26 of the 30 units (response rate = 86%) and all units with > 40 patients. Tobramycin was the drug of choice in all but two centres where there was equivalent use of gentamicin and tobramycin. The survey demonstrated a trend in recent years to reduce the number of doses per day with 54% of centres prescribing once daily, 23% twice daily and 23% thrice daily regimens. Initial dosing was generally based on mg/kg per day (mean 8.8, range 7.5-10 mg/kg per day). Dosing by infusion occurred in 11 of 14 units using once-daily dosing and there was equivalent use of bolus and infusion methods for multiple-daily regimens. Drug monitoring depended on dosing regimen. Units using multiple daily regimens monitored using trough +/- peak levels, whereas 50% of units using once-daily dosing used two postdose levels to alter dose. Actual toxicity, in particular nephrotoxicity, ototoxicity and vestibular toxicity was reported by 19, 27 and 12% of units, respectively.
The prescribing, dosing and monitoring of aminoglycosides in CF across Australia varies greatly. This is likely to be due to a lack of definitive evidence as to the optimum use in this patient group.
确定澳大利亚各囊性纤维化（CF）治疗中心在氨基糖苷类药物临床应用方面的差异。
1999年4月，向澳大利亚各地的30个CF治疗中心发送了一份关于氨基糖苷类药物使用情况的调查问卷。收集了有关静脉给药时药物选择、剂量、监测及毒性方面的信息。
30个中心中有26个完成了调查（回复率 = 86%），且所有中心的患者均超过40例。除两个中心同时等量使用庆大霉素和妥布霉素外，妥布霉素是其他所有中心的首选药物。该调查显示，近年来每日给药次数呈减少趋势，54%的中心采用每日一次给药方案，23%采用每日两次给药方案，23%采用每日三次给药方案。初始剂量一般基于每日毫克/千克（平均8.8，范围为每日7.5 - 10毫克/千克）。在采用每日一次给药方案的14个中心中，有11个通过静脉输注给药，而在多次每日给药方案中，推注和输注方法的使用情况相当。药物监测取决于给药方案。采用多次每日给药方案的中心通过谷浓度±峰浓度进行监测，而采用每日一次给药方案的中心中有50%利用两次给药后血药浓度来调整剂量。分别有19%、27%和12%的中心报告了实际出现的毒性，尤其是肾毒性、耳毒性和前庭毒性。
澳大利亚各地CF治疗中心在氨基糖苷类药物的处方、剂量及监测方面差异很大。这可能是由于缺乏关于该患者群体最佳用药的确切证据。
