Serum tobramycin levels following delivery of tobramycin (Tobi) via eFlow advanced nebuliser in children with cystic fibrosis

J Cyst Fibros. 2010 Jul;9(4):292-5. doi: 10.1016/j.jcf.2010.03.007. Epub 2010 Apr 27.


Background: Safety and toxicity data for nebulised tobramycin are mainly derived from use of the Pari LC Plus nebuliser, yet many centres are now using advanced nebulisers, such as the eFlow.

Methods: Ten children (ages 2-16years) receiving 300mg TOBI via eFlow for clinical reasons participated. Serum tobramycin levels were obtained 1h post nebulisation. Nine provided samples for urinary NAG, and 10 underwent audiology.

Results: Tobramycin levels were >1mg/L in 3 children (maximum 3.8, 2 children aged 2years). Urine NAG/creatinine levels were raised (>0.94micromol/min/mmol) in 5 children, 1 of these had a tobramycin level of >1mg/L. One patient had high frequency hearing loss.

Conclusion: Serum tobramycin levels over 1mg/L can occur 1h post 300mg TOBI delivered by eFlow. Raised urinary NAG levels suggest that some children may have some associated early renal toxicity.

MeSH terms

  • Adolescent
  • Anti-Bacterial Agents / blood
  • Anti-Bacterial Agents / pharmacology*
  • Child
  • Child, Preschool
  • Cystic Fibrosis / drug therapy*
  • Drug Monitoring*
  • Female
  • Humans
  • Male
  • Nebulizers and Vaporizers
  • Pilot Projects
  • Tobramycin / blood
  • Tobramycin / pharmacokinetics*


  • Anti-Bacterial Agents
  • Tobramycin