Abdulhamid Ibrahim, Wise Terri L, Andrews Stephanie, Biglin Kevin, Lehr Victoria Tutag
Division of Pediatric Pulmonary Medicine, Carman and Ann Adams Department of Pediatrics, Children's Hospital of Michigan, 3901 Beaubien Boulevard, Detroit, MI 48201, USA.
Pharmacotherapy. 2008 Jul;28(7):939-44. doi: 10.1592/phco.28.7.939.
High-dose inhaled tobramycin has been increasingly used for treatment and suppression of Pseudomonas aeruginosa pulmonary infections, especially in patients with cystic fibrosis. The advantage of inhalation over other routes of administration is minimal systemic absorption, which reduces the potential for adverse effects. However, cases of adults who had elevated serum concentrations and experienced systemic adverse effects due to excessive systemic absorption after inhaled tobramycin have been reported. We describe a prematurely born infant with numerous congenital and acquired disorders who required assisted mechanical ventilation and a 60-day stay in the neonatal intensive care unit (NICU). Tracheostomy and mechanical ventilatory support were required throughout the infant's hospital stay. The patient developed several pulmonary infections caused by various bacteria. He was treated with multiple antibiotics, including two different dose preparations of inhaled tobramycin 80 mg and 300 mg, administered through the tracheostomy and the ventilator. The infant was given a total of five preparations of tobramycin 80 mg/dose and three of 300 mg/dose, for a total cumulative dose of 1,300 mg over a 6-day period. His tobramycin concentrations increased, prompting discontinuation of the inhaled tobramycin. The infant died on day 60. To our knowledge, this is the first report of elevated tobramycin concentrations after inhalation in an infant. Although studies have found that tobramycin is safe and effective, certain patient populations are more at risk for toxicity. Tobramycin concentrations should be closely monitored in patients with significant underlying renal disorders, especially those in age-group extremes.
高剂量吸入用妥布霉素已越来越多地用于治疗和抑制铜绿假单胞菌肺部感染，尤其是在囊性纤维化患者中。吸入给药相对于其他给药途径的优势在于全身吸收极少，这降低了产生不良反应的可能性。然而，已有报告称成年患者吸入妥布霉素后因全身吸收过多导致血清浓度升高并出现全身不良反应。我们描述了一名患有多种先天性和后天性疾病的早产婴儿，该婴儿需要机械通气辅助，并在新生儿重症监护病房（NICU）住院60天。在婴儿住院期间一直需要气管切开术和机械通气支持。该患者发生了由多种细菌引起的数次肺部感染。他接受了多种抗生素治疗，包括通过气管切开术和呼吸机给予的两种不同剂量制剂的吸入用妥布霉素，分别为80毫克和300毫克。该婴儿总共接受了5次80毫克/剂量的妥布霉素制剂和3次300毫克/剂量的制剂，在6天内累计总剂量为1300毫克。他的妥布霉素浓度升高，促使停用吸入用妥布霉素。该婴儿在第60天死亡。据我们所知，这是关于婴儿吸入妥布霉素后浓度升高的首例报告。尽管研究发现妥布霉素安全有效，但某些患者群体更易出现毒性反应。对于有严重潜在肾脏疾病的患者，尤其是年龄极端的患者，应密切监测妥布霉素浓度。
