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Therapeutic drug monitoring of aminoglycosides: Is achieving PK/PD targets associated with better clinical outcomes in patients with cystic fibrosis?

Year: 2026

Type: article

Abstract: Background Aminoglycosides are widely used in dual antipseudomonal therapy for acute pulmonary exacerbations in cystic fibrosis (CF). Due to altered pharmacokinetics in CF, achieving recommended pharmacokinetic/pharmacodynamic (PK/PD) targets is challenging and the impact of target attainment on clinical outcomes remains unclear. Objectives To evaluate whether currently recommended aminoglycoside dosing regimens in CF achieve PK/PD targets in clinical practice, and whether target attainment correlates with clinical improvements in CF patients. Design/methods A two-year, single-center cohort study was conducted in adult CF patients receiving aminoglycoside during acute exacerbation. Aminoglycoside levels were obtained to estimate PK parameters. Clinical symptoms and pulmonary function were assessed at admission (baseline) and discharge. Results Fourteen treatment courses were analyzed among nine patients. Amikacin (n=10, mean dose 30.9 ± 2 mg/kg), or gentamicin (n=4, mean dose 10.5 ± 0.7 mg/kg) were administered. The target C max :MIC ratio of 8-10 was achieved in 50% of amikacin courses and none of the gentamicin courses. Most patients improved clinically, evident by symptoms’ resolution and increased ppFEV 1 . Target attainment was associated with a numerically greater ppFEV 1 improvement, though not statistically significant (P=0.29). Conclusions The pre-defined PK/PD target was attained in less than half of the cases treated, underscoring the need for optimized dosing strategies. Nonetheless, clinical improvement occurred regardless of target attainment. This highlights the need of larger randomized controlled studies to define the relationship between aminoglycoside PK/PD target achievement and clinical outcomes among CF patients.

Source: Therapeutic Advances in Infectious Disease

DOI: 10.1177/20499361261503133