Complicated Pneumonia
Tobramycin

Tobramycin

Low
N/A
~$15.00/day

Dosing

General Information

Pseudomonal and other gram negative infections.

Inhaled form used in cystic fibrosis.

Monitor creatinine at least 3 times/week. Discontinue if any signs of ototoxicity.

For Multiple daily dosing:

  • Target Peak 4-10 μg/mL
  • Trough 1-2 μg/mL

For Once daily:

  • Target Trough <1 μg/mL.

NB:

  • Trough level is 0-30min before a dose (usually pre-4th)
  • Peak is 30-60min after dose infused (usually post-3rd)

In critically ill patients, check peak level after the 1st dose as volume of distribution and renal function may change rapidly.

Nephrotoxicity (non-oliguric)

  • Avoid concomitant nephrotoxins
  • Less common with once daily dosing
  • Greater toxicity with longer duration and supratherapeutic trough levels

Vestibulocochlear toxicity

  • Irreversible
  • Require audiology testing if prolonged use

Can exacerbate neuromuscular blockade

  • Contraindicated in patients with myasthenia gravis
  • Increased nephrotoxicity
  • Amphotericin B
  • Cyclosporine
  • Cisplatin
  • NSAIDS
  • Contrast dye
  • Vancomycin
  • Increased ototoxicity
  • Furosemide
  • Neuromuscular blockade agents - Respiratory paralysis

Formal audiology assessment if planning to use aminoglycoside for >7d or if symptoms develop.

Inform patient of risk of ototoxicity and to report any symptoms.

Antimicrobial class: Aminoglycoside

Pregnancy category: D

Average serum half life: 2-3 hours

Biliary penetration: Moderate

CSF penetration: Poor

Lung penetration: Therapeutic

Urine penetration: Therapeutic