Antimicrobials
Tobramycin

Tobramycin

C difficile risk
Low
Oral Bioavailability
N/A

Dosing

Multiple Daily Dose (MDD) 2mg/kg IV load then 1.7mg/kg IV q8h

Once Daily (OD) 5-7mg/kg IV q24h IV

0 - 20 eGFR20 - 39 eGFR40 - 59 eGFR60+ eGFR2mg/kg load then dose as per levels1.7mg/kg q24h1.7mg/kg IV q12h1.7mg/kg q8h

0 - 40 eGFR40 - 59 eGFR60+ eGFRAVOID use. If necessary, use conventional aminoglycoside dosing5-7mg/kg q36h5-7mg/kg q24h

2mg/kg load post HD, then 1.5mg/kg post HD

3mg/kg IV load then 2mg/kg IV q24h

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 MDD: Target Peak 4-10 ug/mL, Trough 1-2 ug/mL.

For OD: Target Trough <1 ug/mL

NB: trough level is 0-60min before a dose (usually pre-4th), and 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)- less common with once daily dosing; greater toxicity with longer duration and supratherapeutic trough levels; avoid concomitant nephrotoxins

Vestibulocochlear toxicity (irreversible)- require audiology testing if prolonged use

Can exacerbate neuromuscular blockade- e.g. contraindicated in patients with myasthenia gravis.

Increased nephrotoxicity with: 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 to report any symptoms

Contraindicated in patients with myasthenia gravis

Antimicrobial class: Aminoglycoside

Pregnancy category: D

Average serum half life: 3.0

Biliary penetration: Moderate

CSF penetration: Poor

Lung penetration: Therapeutic

Urine penetration: Therapeutic