The general effect and Nebulisers comparison with inhaled tobramycin in young children
Empirical Formula: C18H37N5O9
Chemical Name: O-3-Amino-3-deoxy-α-D-glucopyranosyl-(1 → 4)-O-[2,6-diamino-2,3,6-trideoxy-α-D-ribo-hexopyranosyl-(1 → 6)]-2-deoxy-L-streptamine
Tobramycin is an aminoglycoside antibiotic derived from Streptomyces tenebrarius and used to treat various types of bacteria infections, particularly Gram-negative infections. It is especially effective against species of Pseudomonas.
Selman Waksman's laboratory at Rutgers University discovered the first aminoglycoside antibiotic, streptomycin, in 1943. Other aminoglycoside antibiotics, such as gentamicin and tobramycin, soon followed. Tobramycin is compatible with most intravenous fluids and tear substitutes, but it is incompatible with heparin and some β-lactam antibiotics such as penicillin and cephalosporins. Due to tobramycin's broad spectrum of activity, it has proven useful in controlling both superficial and deep infections of the eye and ocular adnexa (i.e., blepharitis, conjunctivitis, keratitis, and endophthalmitis). However, since tobramycin has been associated with neuromuscular blockade, as well as possessing ototoxic and nephrotoxic effects, care must be taken to minimize toxicity by monitoring patients undergoing systemic tobramycin therapy.
In Timone University Hospital, each child inhaled 300 mg tobramycin delivered with one or the other apparatus via a facemask in two separate and standardised sessions. Urine was collected for 6 h. Tobramycin concentrations determined by immunoprecipitation were expressed in mg per g of creatinine and compared by a Wilcoxon test for matched pairs. The influences of age, weight and Brasfield score on this parameter were evaluated by correlation tests, and those of sex, previous nebulisation treatment, and crying or coughing were evaluated by Student's t-test.
The amount of tobramycin measured in urines was low and variable. Median values for urinary tobramycin concentration were 47.6 mg/g (14.9–79.6) with the PariLC+ and 42.6 mg/g (6.3–112.8) with the NL9M (p = 0.6). PariLC+ delivered tobramycin in 22 min and NL9M in 12 min (p = 0.005). Crying or coughing dramatically reduced the amount of tobramycin collected.
This pilot study shows that evaluation of nebulisers based on tobramycin renal excretion is feasible in young children with cystic fibrosis.
没有评论:
发表评论