Timing of inhaled tobramycin affects assessment of intravenous tobramycin pharmacokinetic monitoring  Antine E. Stenbit, Wendy M. Bullington, Julie L. Heh, Patrick A. Flume  Journal of Cystic Fibrosis  Volume 12, Issue 4, Pages 403-406 (July 2013) DOI: 10.1016/j.jcf.2012.11.007 Copyright © 2012 European Cystic Fibrosis Society. Terms and Conditions

Fig. 1 Graphical representation of interventions. The open arrows represent the times that the IV tobramycin was given every 12h (Q12h) on Day 1 and Day 2. The smaller arrows are the times at which the serum was collected. The first dose of IV tobramycin was considered time 0 each day. The TIS was given between 5 and 9h after the third dose (morning dose on Day 2). Journal of Cystic Fibrosis 2013 12, 403-406DOI: (10.1016/j.jcf.2012.11.007) Copyright © 2012 European Cystic Fibrosis Society. Terms and Conditions

Fig. 2 Minimum concentration (trough) and elimination rate constant over time of serum tobramycin. A: minimum concentration (trough) of serum tobramycin. The minimum concentration (Cmin) was calculated for each patient on Day 1 and again on Day 2. The graph represents a line for each patient drawn from the Cmin calculated on Day 1 to the Cmin calculated on Day 2. Solid black lines indicate patients whose Cmin increased on Day 2 when compared to Day 1. For our center, if the Cmin is over 1μg/mL, the patient's interval of IV tobramycin will be increased to achieve a Cmin <1μg/mL. The broken black line indicates a Cmin of <1μg/mL. B: elimination rate constant over time. This graph represents a line drawn from the elimination rate constant (ke) calculated on Day 1 (no TIS) to the ke calculated on Day 2 (after TIS) for each patient. Dotted lines indicate patients whose ke decreased on Day 2 when compared to Day 1. Journal of Cystic Fibrosis 2013 12, 403-406DOI: (10.1016/j.jcf.2012.11.007) Copyright © 2012 European Cystic Fibrosis Society. Terms and Conditions