Aerosolized and Instilled Aminoglycosides

Marcel Dekker, Inc. 270 Madison Avenue, New York, New York 10016 

Lack of systemic absorption with gentamicin or tobramycin administered by endotracheal instillation was demonstrated by Crosby et al. (38) in 10 patients with creatinine clearance greater than 40 mL/min however, Odio and colleagues (39) found that significant serum levels were achieved in patients with azotemia when gentamicin 40 mg was instilled every 6 hours. 

Bronchospasm frequently complicates aerosolized polymyxin therapy as a result of mast cell degranulation and histamine release as such, a bronchial challenge is recommended before initiating therapy. Tobramycin may offer an advantage over gentamicin when used in aerosolized therapy because tobramycin is suspended in neutral pH (a condition similar to the respiratory lining 

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