Misleading high tobramycin plasma concentrations can be caused by skin contamination of fingerprick blood following inhalation of nebulized tobramycin (TOBI (R)) - A short report

Redmann, S, Wainwright, C, Stacey, S, Champion, A, Mitchell, P, Cheney, J and Charles, B (2005) Misleading high tobramycin plasma concentrations can be caused by skin contamination of fingerprick blood following inhalation of nebulized tobramycin (TOBI (R)) - A short report. Therapeutic Drug Monitoring, 27 2: 205-207. doi:10.1097/01.ftd.0000155341.16361.62


Author Redmann, S
Wainwright, C
Stacey, S
Champion, A
Mitchell, P
Cheney, J
Charles, B
Title Misleading high tobramycin plasma concentrations can be caused by skin contamination of fingerprick blood following inhalation of nebulized tobramycin (TOBI (R)) - A short report
Journal name Therapeutic Drug Monitoring   Check publisher's open access policy
ISSN 0163-4356
Publication date 2005
Sub-type Article (original research)
DOI 10.1097/01.ftd.0000155341.16361.62
Volume 27
Issue 2
Start page 205
End page 207
Total pages 3
Editor G. Koren
M. Oellerich
Place of publication USA
Publisher Lippincott Williams & Wilkins
Collection year 2005
Language eng
Subject C1
320503 Clinical Pharmacology and Therapeutics
730110 Respiratory system and diseases (incl. asthma)
Abstract We observed unexpected high plasma concentrations of tobrarriycin (48.5 and 28.1 mg/L) in fingerprick blood samples after the nebulization of tobramycin solution for inhalation (tobramycin 300 mg/5 mL, TOBI(R)) by 2 young children aged 3 years. To investigate whether dermal contamination could be the source of error, 3 adult volunteers were present during another nebulization by a third child (age 2 years). The volunteers had exposure to tobramycin by handling the nebulizer or the nebule and also by inhalation from holding the child and being in close proximity while TOBI(R) was being administered. Five blood samples by fingerprick and 2 by venipuncture were collected and assayed for tobramycin concentration. On each occasion the site was swabbed with alcohol wipes to mimic standard patient sampling methods. One site was resampled after cleaning of hands with 2% chlorhexidine gluconate and water. Tobramycin concentrations from venipuncture 1-2 hours after nebulization were all < 0.2 mg/L except for 1 result of 1.2 mg/L. The tobramycin concentrations from fingerpricks before hand washing varied between 6.8 and 172 mg/L, and after hand washing between 0.3 and 17.6 mg/L. Contamination of fingers with tobramycin is likely to have caused the error in the 2 initial cases and did cause misleadingly elevated levels in the adult volunteers. We caution that therapeutic drug monitoring of nebulized tobramycin should not be done by fingerprick sampling, and care should be taken to avoid contamination of the venipuncture site.
Keyword Medical Laboratory Technology
Pharmacology & Pharmacy
Toxicology
Tobramycin Nebulization
Fingerprick
Blood Sampling
Skin Contamination
Cystic Fibrosis
Cystic-fibrosis
Inhaled Tobramycin
Aerosolized Tobramycin
Young-children
Pharmacokinetics
Budesonide
Efficacy
Serum
Q-Index Code C1

Document type: Journal Article
Sub-type: Article (original research)
Collections: Excellence in Research Australia (ERA) - Collection
2006 Higher Education Research Data Collection
School of Pharmacy Publications
 
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Created: Wed, 15 Aug 2007, 06:15:01 EST