ArticleEuropean journal of clinical pharmacology2026
From historical dosing to precision dosing: Modernising tobramycin monitoring in people with cystic fibrosis.
Article in European journal of clinical pharmacology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundHistorical therapeutic drug monitoring (TDM) strategies for intravenous tobramycin in people with cystic fibrosis (pwCF) were developed in the pre-CFTR modulator era and relied predominantly on clearance-based monitoring to minimise toxicity. Contemporary pwCF demonstrate greater variability in body composition and clinical phenotype, potentially limiting the applicability of historical dosing approaches.
methodsIn December 2024, our adult cystic fibrosis centre implemented Bayesian-guided TDM (TDMx
resultsPrior to implementation, 74% of pwCF had not undergone formal dose review for more than three years. Following introduction of Bayesian monitoring, 98% received 24-hourly dosing compared with 33% under the historical protocol. Among pwCF with previous admissions, 72% required dose adjustment. Target C
conclusionsBayesian-guided TDM was feasible, safe, and substantially altered tobramycin prescribing practice. It identified pwCF at risk of both inappropriate dose reduction and underexposure, supporting precision dosing in the evolving CF population.
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