Conclusions
The results of this study indicate that utilization of AUC24, in combination with Cmax, may be beneficial when monitoring IV tobramycin in patients with CF admitted for an APE. The lack of correlation between increasing AUC24 or Cmax and subsequent development of AKI, in combination with the correlation of clinical efficacy and AUC24 ≥80 mg*hr/L, suggest benefit in targeting an AUC24 ≥80 mg*hr/L with minimal risk of additive toxicity. Overall, given the significant correlation between AUC24 and Cmax found within both cohorts, AUC24 may be utilized, in combination with Cmax, to enhance efficacy of IV tobramycin therapy in CF patients being treated for an acute pulmonary exacerbation.
Additionally, given the significant increase in incidence of AKI with multi-daily dosing of tobramycin, in combination with the lack of correlation between time undetectable and efficacy or toxicity found within this study, utilization of once-daily dosing of IV tobramycin should be encouraged in both pediatric and adult patients with CF.