Tobramycin

Indications
 Parenteral
Susceptible infections
Adult: 3-5 mg/kg/day, to be given in 3-4 divided doses for 7-10 days. Dose may be given via IM/IV infusion in 50-100 ml of 0.9% sodium chloride or 5% glucose over 20-60 minutes.
Child: IM/IV infusion over 20-60 min: 6-7.5 mg/kg daily in 3-4 divided doses; premature and full-term neonates: 2 mg/kg bid. Treatment is given for 7-10 days.
Renal impairment: Initial loading dose of 1 mg/kg, subsequent dosage or frequency of admin adjusted based on serum concentration.
Parenteral
Mild to moderate urinary tract infections
Adult: 2-3 mg/kg once daily for 7-10 days. Dose to be given via IM/IV infusion in 50-100 ml of 0.9% sodium chloride or 5% glucose over 20-60 minutes.
Renal impairment: Initial loading dose of 1 mg/kg, subsequent dosage or frequency of admin adjusted based on serum concentration.
Inhalation
Cystic fibrosis
Adult: 300 mg every 12 hr inhaled from a suitable nebuliser for 28 days, then stop for 28 days and repeat in cycles of 28 days as needed. Do not give doses <6 hr apart.
Ophthalmic
Ocular infections
Adult: As 0.3% eye drop: Mild to moderate infections: Instill 1-2 drops into affected eye every 4 hr. Severe infections: Instill 2 drops into affected eye every 30-60 minutes initially until improvement, reduce treatment frequency before discontinuation. As 0.3% eye ointment: Mild to moderate infections: Apply a half-inch ribbon bid-tid into affected eye. Severe infections: Apply a half-inch ribbon into the affected eye every 3-4 hr until improvement, reduce treatment frequency before discontinuation.

Incompatibility: Inactivated by β-lactam-type antibiotics (e.g. penicillins or cephalosporins).
Contraindications
 Hypersensitivity to aminoglycosides; pregnancy.
Warnings / Precautions
 Preexisting renal and auditory or vestibular impairment; dehydration; neuromuscular blockade, muscular disorders (e.g. myasthenia gravis, parkinsonism); neonates; elderly; lactation. Avoid peak plasma concentrations > 10 mcg/ml or trough concentrations >2 mcg/ml when used parenterally.
Adverse Reactions
 Nausea, vomiting, dizziness or vertigo, acute renal failure, interstitial nephritis, acute tubular necrosis, electrolyte imbalances, purpura, encephalopathy, convulsions, mental depression, hallucinations, ototoxicity, blood dyscrasias, increased LFT and bilirubin concentrations. Topical: Ocular toxicity and hypersensitivity reactions (e.g. itching and oedema of the eyelid), conjunctival erythema, punctate keratitis and tearing.
Potentially Fatal: Neuromuscular blockade, respiratory paralysis, anaphylaxis.
Overdose Reactions
 If orally ingested, toxicity is less likely as it is poorly absorbed from an intact GI tract. In parenteral overdose, nephrotoxicity may occur if trough blood concentrations fail to fall below 2 mcg/ml. Auditory and vestibular toxicities may occur in patients treated for >10 days; abnormal renal function; dehydrated patients; or receiving medications with additive auditory toxicities. Ototoxicity signs and symptoms (e.g. dizziness, tinnitus, vertigo, loss of high-tone acuity) may manifest even after the drug has been discontinued. Neuromuscular blockade, respiratory failure and prolonged respiratory paralysis may also occur. Treatment is supportive and symptomatic. Neuromuscular blockade may be reversed by the admin of calcium salts. Monitor fluid balance, creatinine clearance and tobramycin plasma levels until the serum tobramycin level falls below 2 mcg/ml. Ensure adequate hydration in patients with normal renal function. In patients with abnormal renal function, aggressive therapy e.g. haemodialysis may be beneficial.
Drug Interactions
 Increased nephrotoxicity or ototoxicity with etacrynic acid, furosemide, other aminoglycosides, cefalotin, cisplatin, vancomycin, piperacillin, ciclosporin, amphotericin B. Decrease serum tobramycin levels with miconazole.
Potentially Fatal: Increased neuromuscular-blocking activity with magnesium and other neuromuscular-blocking agents.
See Below for More tobramycin Drug Interactions
Mechanism of Actions
 Tobramycin acts by binding to 30S ribosomal subunits thus interfering with bacterial protein synthesis. It is active against many aerobic gram-negative bacteria and some aerobic gram-positive bacteria but inactive against Chlamydia, fungi, viruses, and most anaerobic bacteria.
Absorption: Rapid and complete absorption (IM); peak plasma concentrations after 30-90 min (IM). Poor oral absorption.
Distribution: Crosses the placenta.
Excretion: Via the urine; elimination half-life: 2-3 hr.
Storage Conditions
 Ophthalmic: Store at 8-27°C (46-80°F). Parenteral: Store between 15-30°C (59-86°F).
ATC Classification
 J01GB01 - tobramycin ; Belongs to the class of other aminoglycosides. Used in the systemic treatment of infections.
S01AA12 - tobramycin ; Belongs to the class of antibiotics. Used in the treatment of eye infections.
Storage
 Ophthalmic: Store at 8-27°C (46-80°F). Parenteral: Store between 15-30°C (59-86°F).
Available As
  • Tobramycin 0.3%
  • Tobramycin 0.3% w/v
  • Tobramycin 0.3% w/w
  • Tobramycin 0.457%
  • Tobramycin 10 mg
  • Tobramycin 120 mg
  • Tobramycin 20 mg
  • Tobramycin 3 mg
  • Tobramycin 300 mg
  • Tobramycin 40 mg
  • Tobramycin 60 mg
  • Tobramycin 80 mg

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