Tobramycin
General
- Type: Aminoglycoside
- Dosage Forms: IV
- Common Trade Names: Tobrex
Adult Dosing
Infection, bacterial
- 1-1.7 mg/kg IM/IV q8h
- For extended interval dosing:
- 5-7 mg/kg IV q24h
Pneumonia, Hospital-acquired
- 5-7 mg/kg IV q24h x7 days
Respiratory infections, Cystic fibrosis pts
- 10-12 mg/kg IV q24h
- Alt: 2.5-3.5 mg/kg IV q8h
Endocarditis, Gram positive synergy
- 3 mg/kg IV q24h for at least 2 weeks as part of multi-drug regimen
Pediatric Dosing
Infection, bacterial
- <8 days old
- 2 mg/kg IV/IM q12h
- >8 days old
- 2-2.5 mg/kg IV/IM q8h
Respiratory infections, Cystic fibrosis pts
- >1 mo
- 10-12 mg/kg IV q24h
Febrile neutropenia, post-stem cell transplant
- <5 yo
- 9 mg/kg IV q 24h
- 5-11 yo
- 8 mg/kg IV q24h
- 12+ yo
- 7 mg/kg IV q24h
Endocarditis, Gram positive synergy
- 3-6 mg/kg IV divided q8h as part of multi-drug regimen
Special Populations
- Pregnancy Rating: C
- Lactation: May use, no known risk based on drug properties
- Renal Dosing
- Adult
- CrCl 50-70: Give q8-24h
- CrCl 10-50: Give q24-48h
- CrCl <10: Give q48-72h
- HD: Give 50% usual dose after dialysis
- PD: Give supplement
- Pediatric
- CrCl 30-50: Give q12-18h
- CrCl 10-29: Give q18-24h
- CrCl <10: Give q48-72h
- HD/PD: 2 mg/kg x1 then adjust dose based on serum
- Adult
- Hepatic Dosing
- Adult
- Not defined
- Pediatric
- Not defined
- Adult
Contraindications
- Allergy to class/drug
- Caution:
- Hypersensitivity to sulfites
- Renal Impairment
- Dehydration
- Concurrent nephrotoxic/ototoxic agent
- Impaired auditory/vestibular fxn
- Neuromuscular dz
- Prolonged use
Adverse Reactions
Serious
- Ototoxicity, auditory or vestibular
- Nephrotoxicity, Neurotoxicity
- Neuromuscular blockaed
- Superinfection
- C. Diff associated diarrhea
- Anaphylaxis
- Hypersensitivity rxn
- Exfoliative Dermatitis
- Toxic epidermal necrolysis, Stevens-Johnson Syndrome
- Erythema multiforme
Pharmacology
- Half-life: 2h
- Metabolism: Minimal to none
- Excretion: Renal (100% unchanged)
- Mechanism of Action: Binds to bacterial 30S ribosomal subunit, inhibiting protein synthesis
Antibiotic Sensitivities[1]
Key
- S susceptible/sensitive (usually)
- I intermediate (variably susceptible/resistant)
- R resistant (or not effective clinically)
- S+ synergistic with cell wall antibiotics
- U sensitive for UTI only (non systemic infection)
- X1 no data
- X2 active in vitro, but not used clinically
- X3 active in vitro, but not clinically effective for Group A strep pharyngitis or infections due to E. faecalis
- X4 active in vitro, but not clinically effective for strep pneumonia
See Also
References
- Sanford Guide to Antimicrobial Therapy 2014
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