Antimicrobials
Tobramycin

Tobramycin

Low
N/A
$4.54/Dose $68.17/5 Days

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.
  • Multiple daily (traditional) dosing: Target trough should be < 2 mg/L. Target peak should be < 12 mg/L.
  • Once daily (extended interval) dosing: Target trough should be < 1 mg/L (no need to monitor peak).

N.B. Trough level is ~5min before a dose and peak is ~30min after dose infused (usually around 3rd or 4th dose for traditional dosing). 

Pharmacy consultation recommended for monitoring levels.

Nephrotoxicity (non-oliguric)

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

Vestibulocochlear toxicity

  • May be irreversible
  • Requires audiology testing if prolonged use (>14d)

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.

Do not mix or run penicillins in same tubing.

Formal audiology assessment if planning to use aminoglycoside for >14d or if symptoms develop.

Inform patient of risk of ototoxicity and to report any symptoms (e.g. feeling of fullness in the ears, ringing in the ears, earache, hearing loss, nausea/vomiting, dizziness, loss of balance).

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