Tobramycin
Renal

Renal

Note

Dosing based on IBW, unless actual body weight greater than 20% above IBW, then use dosing weight

Not On Dialysis

Extended Interval Dosing
  • CrCl 40-59: 5-7 mg/kg IV q36h
  • CrCl 20-39: 5-7 mg/kg IV q48h OR Consider conventional dosing
  • CrCl <20: 5-7 mg/kg IV to start, then use serial serum drug levels to adjust OR Consider conventional dosing
Conventional Dosing
  • CrCl 20-49: 1.5-2 mg/kg IV q24h
  • CrCl <20: 1.5-2 mg/kg IV q48-72h OR Single dose, then use serial drug levels to adjust; close monitoring recommended
Synergy Dosing
  • CrCl 20-49: 1 mg/kg IV q24h
  • CrCl <20: 1 mg/kg IV q48-72h OR Single dose, then use serial drug levels to adjust; close monitoring recommended

Note: For Gram positive infections only; tobramycin should not be used for synergy against Enterococcus spp infections (use gentamicin)

Intermittent Hemodialysis (IHD)

1 mg/kg IV at the end of each dialysis session Dose adjustments based on pre-dialysis levels (dosing based on patient's dry weight if not obese; if dry weight is greater than 20% above IBW, then use dosing weight)