Extended-Interval Once-Daily Dosing of Aminoglycosides in Adult and Pediatric Patients with Cystic Fibrosis

Extended‐interval once‐daily dosing with the aminoglycoside tobramycin has been proven to be equally efficacious as traditional thrice‐daily dosing for treatment of the pulmonary exacerbations of cystic fibrosis in adults and children older than 5 years. The frequencies of acute ototoxicity and nephrotoxicity do not appear to be significantly different between patients treated with once‐versus thrice‐daily dosing, and the risk of acute nephrotoxicity may actually be lower in pediatric patients when once‐daily dosing is used. Long‐term studies are needed to fully assess the impact that cumulative treatments with once‐daily dosing have on renal and auditory function. An increase in antimicrobial resistance has been suggested with once‐daily dosing in the cystic fibrosis population. The extended‐interval aminoglycoside dose should be determined based on previous therapeutic drug monitoring. If the patient is aminoglycoside (tobramycin) naïve, a dose of 10 mg/kg once/day is suggested, with the dose adjusted by using therapeutic drug monitoring to individualize therapy.