Bayesian Tobramycin Dosing in Cystic Fibrosis Exposes Hidden Underexposure

This single-centre implementation audit shows how model-informed precision dosing changed intravenous tobramycin practice in modulator-era adults with cystic fibrosis, and why clearance-only trough monitoring may misclassify exposure.

📅 Journal publication: Oct 17, 2026 · Last updated: Oct 19, 2026

tobramycinaminoglycosidesBayesian dosingTDMxtherapeutic drug monitoringmodel-informed precision dosingcystic fibrosisPseudomonas aeruginosaCFTR modulatorselexacaftor/tezacaftor/ivacaftorpharmacokineticsimplementation studyantimicrobial stewardship Pharmacokinetics / TDM

Also in Infectious Disease / Antimicrobials

Background Information

Bayesian TDM redefines tobramycin dosing in cystic fibrosis.

Precision dosing is crucial in cystic fibrosis as variability in tobramycin pharmacokinetics can impact efficacy and safety. Bayesian-guided therapeutic drug monitoring (TDM) improved dosing accuracy, with 98% receiving 24-hourly dosing and 65.2% achieving target maximum concentrations. Bayesian TDM effectively individualized tobramycin dosing, reducing risks of both underexposure and toxicity, and may enhance personalized therapy in cystic fibrosis. Bayesian TDM can optimize tobramycin dosing in cystic fibrosis, improving precision and safety.

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Authors: Johnson E, Williams M, Henderson D, Riddles T, Reid D, Smith D, Burke A, Evans IES

Citation: Johnson E, Williams M, Henderson D, et al. From historical dosing to precision dosing: Modernising tobramycin monitoring in people with cystic fibrosis. European journal of clinical pharmacology. 2026;82(11). doi:10.1007/s00228-026-04205-5

Article Links: PubMed · Journal / DOI

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