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A3650 - Tobramycin Inhalation Solution Prescribing Practices in Non-Cystic Fibrosis Pediatric Patients
Author Block: A. R. Shenoy1, M. Noval2, S. Chan2, K. Ravin3; 1Division of Pulmonology, Nemours/A.I.duPont Hospital for Children, Wilmington, DE, United States, 2Pharmacy, Nemours/A.I.duPont Hospital for Children, Wilmington, DE, United States, 3Division of Infectious Diseases, Nemours/A.I.duPont Hospital for Children, Wilmington, DE, United States.
Rationale: Tobramycin inhalation solution (TIS) is approved for treatment of initial Pseudomonas aeruginosa (PA) infection and later maintenance therapy in Cystic Fibrosis (CF) patients known to be colonized with PA. TIS is prescribed off-label in technology-dependent children with bacterial tracheitis. The majority of TIS therapy in non-CF patients is prescribed based on limited case studies, anecdotal reports or expert medical opinion due to lack of supportive medical literature. This retrospective case series describes TIS pediatric prescription practices in non-CF patients at our tertiary children’s hospital. Methods: Charts of non-CF patients receiving TIS hospitalized between January 2016 and February 2017 were reviewed. Their demographic features, underlying medical diagnoses, prescribing providers, microbiological information, indications, dosage and duration of TIS therapy, and use of concomitant systemic antibiotics were collected. Results: 112 courses of TIS were prescribed to 47 patients. Gender distribution was even- Male 44%, Female 56%. Ethnicity varied from African American (53%), Caucasian/Hispanic (38%), Asian (1%), to ‘preferred not to answer’ (8%). Patients were aged 1 month- 21 years; mean age 5.5 years. 96% had 2 or more underlying diagnoses including: chronic lung disease (79%), chronic neurological disorder (55%), surgical disease/congenital malformation (25%), chromosomal/metabolic disorder (23%), gastrointestinal disease (18%), solid organ transplant (13%), congenital heart disease (11%), prematurity (8%), endocrine disease (7%), hematologic disease (5%), chronic renal disease (1%), not specified (2%). 98% of patients had tracheostomy status. 74% of patients received invasive mechanical ventilation. Prescribing providers were Pulmonology (24%), PICU (22%), Cardiology (22%), General Pediatrics (17%), NICU (9%), and Surgical specialties (4%). Respiratory cultures preceding TIS therapy were obtained via tracheostomy (69%), BAL (27%), Sputum (2%), or ‘other’ (4%). TIS Indications were chronic use/home therapy (19%), tracheitis (16%), PA culture positive (12.5%), tracheostomy status (7%), chronic lung disease (3.5%), pulmonary recommendation (2.5%), increased secretions (2%), other infection (1.5%), myopathy (1%), chronic ventilation (1%), ‘none provided’ (34%). TIS dosing ranged between 300 mg (41%), 150 mg (57%), and 78mg (2%). 97% of prescribers utilized twice daily dosing. Average duration of therapy was 7.5 days (range 1-48 days). 65% of patients received concomitant systemic antibiotics. Conclusions: TIS is commonly prescribed for many non-CF, technology-dependent, pediatric patients. TIS prescribing practices vary between providers at our institution on indications, dosing, duration and use of concomitant antibiotics. Further studies in non-CF patients will be useful to standardize use of inhaled antibiotic dosing, duration, safety profile and emergence of resistance. Funding Source: None.