Antimicrobials
Tobramycin

Tobramycin

Low
N/A
$26.70/day

Dosing

General Information

Tobramycin is not indicated for synergy in Gram positive infections

  • Pseudomonal and other gram negative infections.
  • Inhaled form used in cystic fibrosis.

Serum creatinine whenever initiating any aminoglycoside.

Creatinine and trough level should be monitored AT LEAST twice weekly; more often if unstable renal function or addition of nephrotoxic medications.

Order appropriate trough level for dosage regimen used

  • Once Daily/Extended Interval Dosing
    • Order 6 hour pre-dose level
    • Target level: less than 1 mg/L
  • Multiple Daily Dosing
    • Order tobramycin trough level (0-60 min before a dose)
    • Desired result: less than 2 mg/L

Tobramycin Peaks

  • Are not used in once daily/extended interval regimens
  • For multiple daily dosing regimens, Peaks not commonly measured but if required are collected 30-60 min after dose infused

Nephrotoxicity

  • Avoid concomitant nephrotoxins
  • Less common with once daily dosing
  • Greater toxicity with longer duration and supratherapeutic trough levels
    KEEP DURATION TO MINIMUM POSSIBLE FOR INDICATION BEING TREATED

Vestibulocochlear toxicity

  • Irreversible
  • Require audiology testing if prolonged use

Other

  • 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.

IV Administration: Dilute in 100 mL D5W or NS and administer over 30-60 min. (*60 min for extended interval dosing)

IV: N/A

Nebules: generic are open benefit

TOBI brand require Special Authorization (CF)

Antimicrobial class: Aminoglycoside

Pregnancy category: D

Average serum half life: 3 hours

Urine penetration: Therapeutic

Lung penetration: Therapeutic

CSF penetration: Poor

Biliary penetration: Moderate

Route of Elimination: Renal