General Information

Pseudomonal and other gram negative infections.

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

For multiple daily dosing: 

  • Target Peak Disease Specific
  • Target trough < 1 ug/mL
  • UTI: 4-6 ug/mL
  • Soft tissue, pyelonephritis, sepsis: 6-8 ug/mL
  • Pneumonia: 8-10 ug/mL     

For once daily dosing: 

  • Target Trough <1 ug/mL
  • Target peak 5mg/kg: 13-16 ug/mL
  • Target peak 7mg/kg: 17-23 ug/mL

Inhaled tobramycin (using IV formulation): 80mg inhaled BID

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
  • Cisplatin
  • Contrast dye
  • Cyclosporine
  • Vancomycin

Increased ototoxicity

  • Loop diuretics (e.g. 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 (short courses during pregnancy have been demonstrated as safe)

Average serum half life: 3 hours

Biliary penetration: Moderate

CSF penetration: Poor

Lung penetration: Therapeutic

Urine penetration: Therapeutic