Elevated tobramycin concentrations following endotracheal administration in a premature infant.

The following case report describes a 1-month-old, 34-week-gestation premature neonate who had compromised renal function. The neonate received endotracheally administered tobramycin (300 mg every 12 hours) via a PARI PLUS reusable nebulizer to treat a documented Gram-negative tracheostomy infection. The patient also received systemic tobramycin (2.5 mg/kg intravenously every 18 hours). The tobramycin serum concentration obtained 45 hours after the last intravenous dose and 11.5 hours after the second nebulized dose was 17.6 mg/L. The tobramycin nebulizations were stopped.