Drug Monitoring

Drug Monitoring Guidelines for Home IV Therapy

Patients with cystic fibrosis (CF) may receive home IV therapy to treat pulmonary exacerbations.  Below are suggested monitoring parameters for home IV.

Antibiotic Possible adverse drug reaction Suggested monitoring parameter

Penicillins

Eg. Cloxacillin

GI intolerance

Rash

Phlebitis

Interstitial nephritis (rare)

Leukopenia (rare)

ONCE weekly:

  • CBC, diff
  • Electrolytes (for antipseudomonal penicillins)
  • ​SCr, urea

Anti-pseudomonal penicillins

Eg. piperacillin/tazobactam

GI intolerance

Rash

Phlebitis

Interstitial nephritis (rare)

Leukopenia (rare)

ONCE weekly:

CBC, diff
Electrolytes (for antipseudomonal penicillins)
​SCr, urea

Cephalosporins

Eg. Ceftazidime

GI intolerance

Rash

Leukopenia (rare)

ONCE weekly:

CBC, diff
Electrolytes (for antipseudomonal penicillins)
​SCr, urea

Carbapenems

Eg. Meropenem

GI intolerance

Rash

Phlebitis

Interstitial nephritis (rare)

Leukopenia (rare)

ONCE weekly:

CBC, diff
Electrolytes (for antipseudomonal penicillins)
​SCr, urea

Aminoglycosides

Eg. Amikacin, tobramycin

Nephrotoxicity

Ototoxicity

Vestibular toxicity

TWICE weekly:

  • CBC, diff
  • SCr, urea

Pre/post dose level with third dose, then if therapeutic pre dose level ONCE weekly*

Consider audiometry

Aztreonam

GI intolerance

Rash

Leukopenia

Elevated AST/ALT

ONCE weekly:

  • CBC, diff
  • SCr, urea
  • AST, ALT
Colistimethate

Nephrotoxicity

Neurotoxicity (eg. Peripheral neuropathies)

TWICE weekly:

  • CBC, diff
  • SCr, urea
Vancomycin

Redman’s syndrome

Phlebitis

Nephrotoxicity (rare)

Leukopenia (rare)

ONCE weekly:

  • CBC, diff
  • SCr, urea
  • Pre dose level*

 

 

*Levels: Peak (mg/L) Trough (mg/L)
Amikacin 25-30 < 10
Tobramycin once daily 20-30 < 1
Tobramycin conventional 10-12 < 2
Vancomycin    n/a       15-20

 

Mandate

The St. Paul’s Hospital Adult Cystic Fibrosis Program is committed to improving the quality of life and health outcomes of individuals living with CF.

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