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Once-daily tobramycin in the treatment of adult patients with cystic fibrosis

¹ Dept of Pharmacy, Leeds Teaching Hospitals, Leeds, ² Regional Adult Cystic Fibrosis Unit, Seacroft Hospital, Leeds, ³ Dept of Pharmacy, Wirral Hospital, Merseyside, and Dept of Pharmacy and Chemistry, Liverpool John Moores University, Liverpool, ⁴ Dept of Audiology, St James's Hospital, Leeds, ⁵ Aysgarth Statistics, Beaconsfield, UK

CORRESPONDENCE: S.P. Conway, Seacroft Hospital, York Road, Leeds, LS14 6UH, UK. Fax: 44 1132063738. E-mail: steven.conway@leedsth.nhs.uk

Keywords: aminoglycosides, cystic fibrosis, tobramycin

Received: March 6, 2001
Accepted September 17, 2001

The aim of this study was to test the equivalence of once- and thrice-daily dosing with tobramycin by comparing efficacy and safety in adult patients with cystic fibrosis.

Sixty adult patients with an acute respiratory exacerbation were randomized to receive either 10 mg·kg^–1 tobramycin once-daily or 3.3 mg·kg^–1 tobramycin thrice-daily. Primary efficacy and safety endpoints were defined as changes in respiratory function and changes in renal function and hearing.

Both groups showed a significant increase in respiratory function without a clinically significant change in renal function. For changes in forced vital capacity % predicted and serum potassium and magnesium levels, equivalence was demonstrated. For the variables forced expiratory volume in one second and forced mid-expiratory flow % pred and serum creatinine levels, there was insufficient power to demonstrate equivalence. One patient in each group showed bilateral impairment in pure tone audiogram after treatment.

This study demonstrated significant clinical improvement with both once- and thrice-daily tobramycin dosing. Equivalence between the two regimens was shown for some, but not all primary endpoints. Once-daily dosing should be used with careful monitoring of safety and efficacy until large multicentre studies confirm these encouraging results.

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