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Dhanani JA, Goodman S, Ahern B, Cohen J, Fraser JF, Barnett A, Diab S, Bhatt M, Roberts JA. Comparative lung distribution of radiolabeled tobramycin between nebulized and intravenous administration in a mechanically-ventilated ovine model, an observational study. Int J Antimicrob Agents 2020; 57:106232. [PMID: 33232733 DOI: 10.1016/j.ijantimicag.2020.106232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Revised: 09/15/2020] [Accepted: 11/14/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND Ventilator-associated pneumonia is common and is treated using nebulized antibiotics. Although adequate pulmonary biodistribution is important for antibiotic effect, there is a lack of data for both intravenous (IV) and nebulized antibiotic administration during mechanical ventilation. OBJECTIVE To describe the comparative pulmonary regional distribution of IV and nebulized technetium-99m-labeled tobramycin (99mTc-tobramycin) 400 mg in a mechanically-ventilated ovine model. METHODS The study was performed in a mechanically-ventilated ovine model. 99mTc-tobramycin 400 mg was obtained using a radiolabeling process. Computed tomography (CT) was performed. Ten sheep were given 99mTc-tobramycin 400 mg via either an IV (five sheep) or nebulized (five sheep) route. Planar images (dorsal, ventral, left lateral and right lateral) were obtained using a gamma camera. Blood samples were obtained every 15 min for 1 h (4 time points) and lung, liver, both kidney, and urine samples were obtained post-mortem. RESULTS Ten sheep were anesthetized and mechanically ventilated. Whole-lung deposition of nebulized 99mTc-tobramycin 400 mg was significantly lower than with IV (8.8% vs. 57.1%, P<0.001). For both administration routes, there was significantly lower deposition in upper lung zones compared with the rest of the lungs. Dorsal deposition was significantly higher with nebulized 99mTc-tobramycin 400 mg compared with IV (68.9% vs. 58.9%, P=0.003). Lung concentrations of 99mTc-tobramycin were higher with IV compared with nebulized administration. There were significantly higher concentrations of 99mTc-tobramycin in blood, liver and urine with IV administration compared with nebulized. CONCLUSIONS Nebulization resulted in lower whole and regional lung deposition of 99mTc-tobramycin compared with IV administration and appeared to be associated with low blood and extra-pulmonary organ concentrations.
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Affiliation(s)
- Jayesh A Dhanani
- UQ Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Brisbane, Australia; Department of Intensive Care Medicine, Royal Brisbane & Women's Hospital, Brisbane, Australia; Critical Care Research Group, The University of Queensland, Brisbane, Australia.
| | - Steven Goodman
- Department of Nuclear Medicine and Specialised PET Services Queensland, The Royal Brisbane and Women's Hospital, Herston, Queensland, Australia
| | - Benjamin Ahern
- School of Veterinary Science, Faculty of Science, University of Queensland, Gatton, Australia
| | - Jeremy Cohen
- UQ Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Brisbane, Australia; Department of Intensive Care Medicine, Royal Brisbane & Women's Hospital, Brisbane, Australia
| | - John F Fraser
- Critical Care Research Group, The University of Queensland, Brisbane, Australia
| | - Adrian Barnett
- Institute of Health and Biomedical Innovation & School of Public Health and Social Work, Queensland University of Technology, Kelvin Grove, Brisbane, Australia
| | - Sara Diab
- Critical Care Research Group, The University of Queensland, Brisbane, Australia
| | - Manoj Bhatt
- Department of Nuclear Medicine and Specialised PET Services Queensland, The Royal Brisbane and Women's Hospital, Herston, Queensland, Australia
| | - Jason A Roberts
- UQ Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Brisbane, Australia; Department of Intensive Care Medicine, Royal Brisbane & Women's Hospital, Brisbane, Australia; Centre for Translational Anti-infective Pharmacodynamics, School of Pharmacy, The University of Queensland, Brisbane, Australia; Department of Pharmacy, Royal Brisbane & Women's Hospital, Brisbane, Australia
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Dhanani JA, Lipman J, Pincus J, Townsend S, Livermore A, Wallis SC, Pandey S, Abdul-Aziz MH, Roberts JA. Pharmacokinetics of Sulfamethoxazole and Trimethoprim During Venovenous Extracorporeal Membrane Oxygenation: A Case Report. Pharmacotherapy 2020; 40:713-717. [PMID: 32378219 DOI: 10.1002/phar.2413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Extracorporeal membrane oxygenation (ECMO) therapy could affect drug concentrations via adsorption onto the oxygenator and/or associated circuit. We describe a case of a 33-year-old man with severe respiratory failure due to Pneumocystis jirovecii infection on a background of recently diagnosed human immunodeficiency virus infection. He required venovenous ECMO therapy for refractory respiratory failure. Intravenous sulfamethoxazole-trimethoprim (100 and 20 mg/kg/day) was administered in a dosing regimen every 6 hours. Pre-oxygenator, post-oxygenator, and arterial blood samples were collected after antibiotic administration and were analyzed for total sulfamethoxazole and trimethoprim concentrations. The peak sulfamethoxazole and trimethoprim concentrations were 122 mg/L and 5.3 mg/L, respectively. The volume of distribution for sulfamethoxazole was 0.37 and 2.30 L/kg for trimethoprim. The clearance for sulfamethoxazole was 0.35 ml/minute/kg and for trimethoprim was 1.64 ml/minute/kg. The pharmacokinetics of sulfamethoxazole and trimethoprim appear not to be affected by ECMO therapy, and dosing adjustment may not be required.
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Affiliation(s)
- Jayesh A Dhanani
- Faculty of Medicine, University of Queensland Centre of Clinical Research, The University of Queensland, Brisbane, Queensland, Australia.,School of Nursing, Queensland University of Technology, Brisbane, Queensland, Australia.,Department of Intensive Care Medicine, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia
| | - Jeffrey Lipman
- Faculty of Medicine, University of Queensland Centre of Clinical Research, The University of Queensland, Brisbane, Queensland, Australia.,Department of Intensive Care Medicine, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia
| | - Jason Pincus
- Department of Intensive Care Medicine, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia.,School of Medicine, University of Queensland, Herston, Queensland, Australia
| | - Shane Townsend
- Department of Intensive Care Medicine, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia.,School of Medicine, University of Queensland, Herston, Queensland, Australia
| | - Amelia Livermore
- Department of Intensive Care Medicine, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia
| | - Steven C Wallis
- Faculty of Medicine, University of Queensland Centre of Clinical Research, The University of Queensland, Brisbane, Queensland, Australia
| | - Saurabh Pandey
- University Of Queensland Centre for Clinical Research, University of Queensland, Herston, Queensland, Australia
| | - Mohd H Abdul-Aziz
- Faculty of Medicine, University of Queensland Centre of Clinical Research, The University of Queensland, Brisbane, Queensland, Australia
| | - Jason A Roberts
- Faculty of Medicine, University of Queensland Centre of Clinical Research, The University of Queensland, Brisbane, Queensland, Australia.,Department of Intensive Care Medicine, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia.,Department of Pharmacy, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia.,Centre for Translational Anti-infective Pharmacodynamics, School of Pharmacy, The University of Queensland, Brisbane, Queensland, Australia.,Division of Anaesthesiology Critical Care Emergency and Pain Medicine, Nîmes University Hospital, University of Montpellier, Nîmes, France
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Dhanani JA, Lipman J, Pincus J, Townsend S, Livermore A, Wallis SC, Abdul-Aziz MH, Roberts JA. Pharmacokinetics of Total and Unbound Cefazolin during Veno-Arterial Extracorporeal Membrane Oxygenation: A Case Report. Chemotherapy 2019; 64:115-118. [PMID: 31610538 DOI: 10.1159/000502474] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Accepted: 08/02/2019] [Indexed: 11/19/2022]
Abstract
Extra-corporeal membrane oxygenation (ECMO) therapy could affect effective drug concentrations via adsorption onto the oxygenator or associated circuit. We describe a case of a 25-year-old female who required a veno-arterial ECMO therapy for refractory cardiac arrest due to massive pulmonary embolism. She had mild renal dysfunction as a result of the cardiac arrest. A total of 2 g of intravenous cefazolin 8-hourly was administered. Pre- and post-oxygenator blood samples were collected at 0, 1, 4, and 8 h post antibiotic administration. Samples were analyzed for total and unbound cefazolin concentrations. Protein binding was ∼60%. Clearance was reduced due to impaired renal function. The pharmacokinetics of cefazolin appear to not be affected by ECMO therapy and dosing adjustment may not be required.
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Affiliation(s)
- Jayesh A Dhanani
- University of Queensland Centre of Clinical Research, Faculty of Medicine, The University of Queensland, Herston, Queensland, Australia, .,Queensland University of Technology, School of Nursing, Herston, Queensland, Australia, .,Department of Intensive Care Medicine, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia,
| | - Jeffrey Lipman
- University of Queensland Centre of Clinical Research, Faculty of Medicine, The University of Queensland, Herston, Queensland, Australia.,Department of Intensive Care Medicine, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia
| | - Jason Pincus
- Department of Intensive Care Medicine, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia.,School of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Shane Townsend
- Department of Intensive Care Medicine, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia.,School of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Amelia Livermore
- Department of Intensive Care Medicine, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia
| | - Steven C Wallis
- University of Queensland Centre of Clinical Research, Faculty of Medicine, The University of Queensland, Herston, Queensland, Australia
| | - Mohd H Abdul-Aziz
- University of Queensland Centre of Clinical Research, Faculty of Medicine, The University of Queensland, Herston, Queensland, Australia
| | - Jason A Roberts
- University of Queensland Centre of Clinical Research, Faculty of Medicine, The University of Queensland, Herston, Queensland, Australia.,Department of Intensive Care Medicine, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia.,Department of Pharmacy, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia.,Centre for Translational Anti-infective Pharmacodynamics, School of Pharmacy, The University of Queensland, Brisbane, Queensland, Australia
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Dhanani JA, Roberts J, Reade MC. Nebulized Tranexamic Acid Therapy for Hemoptysis Associated with Submassive Pulmonary Embolism. J Aerosol Med Pulm Drug Deliv 2019; 33:12-14. [PMID: 31161941 DOI: 10.1089/jamp.2019.1534] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Hemoptysis and pulmonary embolism (PE) are life-threatening pulmonary emergencies that, when present together, create a therapeutic conundrum. We present an illustrative case of a 65-year-old man with unprovoked submassive PE and moderate hemoptysis due to pulmonary infarction. Hemoptysis precluded systemic anticoagulation. Failing a conservative management strategy, we administered nebulized tranexamic acid. After four doses of nebulized tranexamic acid 500 mg, 6 hours apart, hemoptysis had ceased. Systemic anticoagulation with intravenous heparin was then successfully commenced 12 hours after the last episode of hemoptysis. The patient was weaned off high-flow nasal oxygen therapy over the course of the next 5 days with no hemoptysis recurrence. Noting the absence of trial evidence, but good pharmacological rationale and our positive experience, we suggest tranexamic acid is a useful noninvasive treatment option for the management of such conditions. Consent for this publication was obtained from the patient.
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Affiliation(s)
- Jayesh A Dhanani
- UQ Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Brisbane, Australia.,Department of Intensive Care Medicine, Royal Brisbane & Women's Hospital, Brisbane, Australia.,Burns, Trauma and Critical Care Research Centre, University of Queensland, Brisbane, Australia
| | - Jason Roberts
- UQ Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Brisbane, Australia.,Department of Intensive Care Medicine, Royal Brisbane & Women's Hospital, Brisbane, Australia.,Centre for Translational Anti-Infective Pharmacodynamics, School of Pharmacy, The University of Queensland, Brisbane, Australia.,Department of Pharmacy, Royal Brisbane & Women's Hospital, Brisbane, Australia
| | - Michael C Reade
- Department of Intensive Care Medicine, Royal Brisbane & Women's Hospital, Brisbane, Australia.,Burns, Trauma and Critical Care Research Centre, University of Queensland, Brisbane, Australia.,Joint Health Command, Australian Defence Force, Canberra, Australia
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Dhanani JA, Cohen J, Parker SL, Chan HK, Tang P, Ahern BJ, Khan A, Bhatt M, Goodman S, Diab S, Chaudhary J, Lipman J, Wallis SC, Barnett A, Chew M, Fraser JF, Roberts JA. A research pathway for the study of the delivery and disposition of nebulised antibiotics: an incremental approach from in vitro to large animal models. Intensive Care Med Exp 2018; 6:17. [PMID: 29998357 PMCID: PMC6041222 DOI: 10.1186/s40635-018-0180-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2018] [Accepted: 06/04/2018] [Indexed: 11/10/2022] Open
Abstract
Background Nebulised antibiotics are frequently used for the prevention or treatment of ventilator-associated pneumonia. Many factors may influence pulmonary drug concentrations with inaccurate dosing schedules potentially leading to therapeutic failure and/or the emergence of antibiotic resistance. We describe a research pathway for studying the pharmacokinetics of a nebulised antibiotic during mechanical ventilation using in vitro methods and ovine models, using tobramycin as the study antibiotic. Methods In vitro studies using a laser diffractometer and a bacterial-viral filter were used to measure the effect of the type and size of tracheal tubes and antibiotic concentration on the particle size distribution of the tobramycin 400 mg (4 ml; 100 mg/ml) and 160 mg (4 ml, 40 mg/ml) aerosol and nebulised mass delivered. To compare the regional drug distribution in the lung of two routes (intravenous and nebulised) of drug administration of tobramycin 400 mg, technetium-99m-labelled tobramycin 400 mg with planar nuclear medicine imaging was used in a mechanically ventilated ovine model. To measure tobramycin concentrations by intravenous and nebulised tobramycin 400 mg (4 ml, 100 mg/ml) administration in the lung interstitial space (ISF) fluid and blood of mechanically ventilated sheep, the microdialysis technique was used over an 8-h duration. Results Tobramycin 100 mg/ml achieved a higher lung dose (121.3 mg) compared to 40 mg/ml (41.3 mg) solution. The imaging study with labelled tobramycin indicated that nebulised tobramycin distributed more extensively into each lung zone of the mechanically ventilated sheep than intravenous administration. A higher lung ISF peak concentration of tobramycin was observed with nebulised tobramycin (40.8 mg/l) compared to intravenous route (19.0 mg/l). Conclusions The research methods appear promising to describe lung pharmacokinetics for formulations intended for nebulisation during mechanical ventilation. These methods need further validation in an experimental pneumonia model to be able to contribute toward optimising dosing regimens to inform clinical trials and/or clinical use.
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Affiliation(s)
- Jayesh A Dhanani
- Faculty of Medicine, UQ Centre for Clinical Research, The University of Queensland, Brisbane, Australia. .,Department of Intensive Care Medicine, Royal Brisbane and Women's Hospital, Brisbane, Australia. .,Critical Care Research Group, The University of Queensland, Brisbane, Australia.
| | - Jeremy Cohen
- Faculty of Medicine, UQ Centre for Clinical Research, The University of Queensland, Brisbane, Australia.,Department of Intensive Care Medicine, Royal Brisbane and Women's Hospital, Brisbane, Australia
| | - Suzanne L Parker
- Faculty of Medicine, UQ Centre for Clinical Research, The University of Queensland, Brisbane, Australia
| | - Hak-Kim Chan
- Advanced Drug Delivery Group, Faculty of Pharmacy, The University of Sydney, Sydney, New South Wales, Australia
| | - Patricia Tang
- Advanced Drug Delivery Group, Faculty of Pharmacy, The University of Sydney, Sydney, New South Wales, Australia
| | - Benjamin J Ahern
- Faculty of Science, School of Veterinary Science, The University of Queensland, Gatton, Australia
| | - Adeel Khan
- Faculty of Science, School of Veterinary Science, The University of Queensland, Gatton, Australia
| | - Manoj Bhatt
- Department of Nuclear Medicine and Specialised PET Services Queensland, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia.,School of Medicine, Faculty of Health Sciences, University of Queensland, St Lucia, Queensland, Australia
| | - Steven Goodman
- Department of Nuclear Medicine and Specialised PET Services Queensland, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia
| | - Sara Diab
- Critical Care Research Group, The University of Queensland, Brisbane, Australia
| | - Jivesh Chaudhary
- Critical Care Research Group, The University of Queensland, Brisbane, Australia
| | - Jeffrey Lipman
- Faculty of Medicine, UQ Centre for Clinical Research, The University of Queensland, Brisbane, Australia.,Department of Intensive Care Medicine, Royal Brisbane and Women's Hospital, Brisbane, Australia.,Faculty of Health, Queensland University of Technology, Brisbane, Australia
| | - Steven C Wallis
- Faculty of Medicine, UQ Centre for Clinical Research, The University of Queensland, Brisbane, Australia
| | - Adrian Barnett
- Institute of Health and Biomedical Innovation and School of Public Health and Social Work, Queensland University of Technology, Kelvin Grove, Brisbane, Australia
| | - Michelle Chew
- Department of Anaesthesiology and Intensive Care, Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
| | - John F Fraser
- Critical Care Research Group, The University of Queensland, Brisbane, Australia
| | - Jason A Roberts
- Faculty of Medicine, UQ Centre for Clinical Research, The University of Queensland, Brisbane, Australia.,Department of Intensive Care Medicine, Royal Brisbane and Women's Hospital, Brisbane, Australia.,Centre for Translational Anti-infective Pharmacodynamics, School of Pharmacy, The University of Queensland, Brisbane, Australia.,Department of Pharmacy, Royal Brisbane and Women's Hospital, Brisbane, Australia
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Dhanani JA, Parker SL, Lipman J, Wallis SC, Cohen J, Fraser J, Barnett A, Chew M, Roberts JA. Recovery rates of combination antibiotic therapy using in vitro microdialysis simulating in vivo conditions. J Pharm Anal 2018; 8:407-412. [PMID: 30595948 PMCID: PMC6308031 DOI: 10.1016/j.jpha.2018.07.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2018] [Revised: 07/05/2018] [Accepted: 07/06/2018] [Indexed: 11/18/2022] Open
Abstract
Microdialysis is a technique used to measure the unbound antibiotic concentration in the interstitial spaces, the target site of action. In vitro recovery studies are essential to calibrating the microdialysis system for in vivo studies. The effect of a combination of antibiotics on recovery into microdialysate requires investigation. In vitro microdialysis recovery studies were conducted on a combination of vancomycin and tobramycin, in a simulated in vivo model. Comparison was made between recoveries for three different concentrations and three different perfusate flow rates. The overall relative recovery for vancomycin was lower than that of tobramycin. For tobramycin, a concentration of 20μg/mL and flow rate of 1.0μL/min had the best recovery. A concentration of 5.0μg/mL and flow rate of 1.0μL/min yielded maximal recovery for vancomycin. Large molecular size and higher protein binding resulted in lower relative recoveries for vancomycin. Perfusate flow rates and drug concentrations affected the relative recovery when a combination of vancomycin and tobramycin was tested. Low perfusate flow rates were associated with higher recovery rates. For combination antibiotic measurement which includes agents that are highly protein bound, in vitro studies performed prior to in vivo studies may ensure the reliable measurement of unbound concentrations.
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Affiliation(s)
- Jayesh A. Dhanani
- Burns, Trauma and Critical Care Research Centre, The University of Queensland, UQ Centre for Clinical Research, Herston, Brisbane, QLD 4029, Australia
- Department of Intensive Care Medicine, Royal Brisbane & Women's Hospital, Brisbane, Australia
- Corresponding author at: Burns, Trauma and Critical Care Research Centre, The University of Queensland, UQ Centre for Clinical Research, Herston, Brisbane, QLD 4029, Australia.
| | - Suzanne L. Parker
- Burns, Trauma and Critical Care Research Centre, The University of Queensland, UQ Centre for Clinical Research, Herston, Brisbane, QLD 4029, Australia
| | - Jeffrey Lipman
- Burns, Trauma and Critical Care Research Centre, The University of Queensland, UQ Centre for Clinical Research, Herston, Brisbane, QLD 4029, Australia
- Department of Intensive Care Medicine, Royal Brisbane & Women's Hospital, Brisbane, Australia
- Faculty of Health, Queensland University of Technology, Brisbane, Australia
| | - Steven C. Wallis
- Burns, Trauma and Critical Care Research Centre, The University of Queensland, UQ Centre for Clinical Research, Herston, Brisbane, QLD 4029, Australia
| | - Jeremy Cohen
- Burns, Trauma and Critical Care Research Centre, The University of Queensland, UQ Centre for Clinical Research, Herston, Brisbane, QLD 4029, Australia
- Department of Intensive Care Medicine, Royal Brisbane & Women's Hospital, Brisbane, Australia
| | - John Fraser
- Critical Care Research Group, The University of Queensland, Brisbane, Australia
| | - Adrian Barnett
- Institute of Health and Biomedical Innovation & School of Public Health and Social Work, Queensland University of Technology, Kelvin Grove, Brisbane, Australia
| | - Michelle Chew
- Department of Anaesthesiology and Intensive Care, and Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
| | - Jason A. Roberts
- Burns, Trauma and Critical Care Research Centre, The University of Queensland, UQ Centre for Clinical Research, Herston, Brisbane, QLD 4029, Australia
- Department of Intensive Care Medicine, Royal Brisbane & Women's Hospital, Brisbane, Australia
- School of Pharmacy, The University of Queensland, Brisbane, Australia
- Department of Pharmacy, Royal Brisbane & Women's Hospital, Brisbane, Australia
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Dhanani JA, Tang P, Wallis SC, Parker SL, Pandey P, Fraser JF, Cohen J, Barnett A, Roberts JR, Chan HK. Characterisation of 40 mg/ml and 100 mg/ml tobramycin formulations for aerosol therapy with adult mechanical ventilation. Pulm Pharmacol Ther 2018; 50:93-99. [PMID: 29679678 DOI: 10.1016/j.pupt.2018.04.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2018] [Revised: 03/07/2018] [Accepted: 04/09/2018] [Indexed: 11/28/2022]
Abstract
BACKGROUND Preservative-free tobramycin is commonly used as aerosolized therapy for ventilator associated pneumonia. The comparative delivery profile of the formulations of two different concentrations (100 mg/ml and 40 mg/ml) is unknown. This study aims to evaluate the aerosol characteristics of these tobramycin formulations in a simulated adult mechanical ventilation model. METHODS Simulated adult mechanical ventilation set up and optimal settings were used in the study. Inhaled mass study was performed using bacterial/viral filters at the tip of the tracheal tube and in the expiratory limb of circuit. Laser diffractometer was used for characterising particle size distribution. The physicochemical characteristics of the formulations were described and nebulization characteristics compared using two airways, an endotracheal tube (ET) and a tracheostomy tube (TT). For each type of tube, three internal tube diameters were studied, 7 mm, 8 mm and 9 mm. RESULTS The lung dose was significantly higher for 100 mg/ml solution (mean 121.3 mg vs 41.3 mg). Viscosity was different (2.11cp vs 1.58cp) for 100 mg/ml vs 40 mg/ml respectively but surface tension was similar. For tobramycin 100 mg/ml vs 40 mg/ml, the volume median diameter (2.02 vs 1.9 μm) was comparable. The fine particle fraction (98.5 vs 85.4%) was higher and geometric standard deviation (1.36 vs 1.62 μm) was significantly lower for 100 mg/ml concentration. Nebulization duration was longer for 100 mg/ml solution (16.9 vs 10.1 min). The inhaled dose percent was similar (30%) but the exhaled dose was higher for 100 mg/ml solution (18.9 vs 10.4%). The differences in results were non-significant for type of tube or size except for a small but statistically significant reduction in inhaled mass with TT compared to ET (0.06%). CONCLUSION Aerosolized tobramycin 100 mg/ml solution delivered higher lung dose compared to tobramycin 40 mg/ml solution. Tracheal tube type or size did not influence the aerosol characteristics and delivery parameters.
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Affiliation(s)
- Jayesh A Dhanani
- UQ Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Brisbane, Australia; Department of Intensive Care Medicine, Royal Brisbane & Women's Hospital, Brisbane, Australia.
| | - Patrician Tang
- Advanced Drug Delivery Group, Faculty of Pharmacy, The University of Sydney, Sydney, NSW, Australia
| | - Steven C Wallis
- UQ Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Brisbane, Australia
| | - Suzanne L Parker
- UQ Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Brisbane, Australia
| | - Preeti Pandey
- School of Pharmacy, Pharmacy Australia Centre of Excellence, The University of Queensland, Brisbane, Australia
| | - John F Fraser
- Critical Care Research Group, The University of Queensland, Brisbane, Australia
| | - Jeremy Cohen
- UQ Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Brisbane, Australia; Department of Intensive Care Medicine, Royal Brisbane & Women's Hospital, Brisbane, Australia
| | - Adrian Barnett
- Institute of Health and Biomedical Innovation & School of Public Health and Social Work, Queensland University of Technology, Kelvin Grove, Brisbane, Australia; Critical Care Research Group, The University of Queensland, Brisbane, Australia
| | - Jason R Roberts
- UQ Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Brisbane, Australia; Department of Intensive Care Medicine, Royal Brisbane & Women's Hospital, Brisbane, Australia; Centre for Translational Anti-infective Pharmacodynamics, School of Pharmacy, The University of Queensland, Brisbane, Australia; Department of Pharmacy, Royal Brisbane & Women's Hospital, Brisbane, Australia
| | - Hak-Kim Chan
- Advanced Drug Delivery Group, Faculty of Pharmacy, The University of Sydney, Sydney, NSW, Australia
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Dhanani JA, McCarthy J, Fraser JF. The dRTA-rhabdomyolysis connection. Anaesth Intensive Care 2012; 40:728-730. [PMID: 22813515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
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