항생제
Tobramycin

Tobramycin

Low
N/A

Spectrum Of Activity

General Information

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

Black Box Warning: Patients with impaired renal function, advanced age, dehydration, and those who receive high dosage or prolonged therapy are at an increased risk of toxicity. Monitor renal and auditory function during therapy and discontinue therapy or adjust dose if there is evidence of ototoxicity or nephrotoxicity. Concurrent use of other potentially neurotoxic or nephrotoxic agents, or potent diuretics should be avoided. Tobramycin should be used with caution in premature and neonatal infants.

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

For multiple daily dosing: Target peak 4-10 ug/mL, Trough 1-2 ug/mL.

For once daily: Target trough <1 ug/mL

NB: Trough level is 0-60 min before a dose (usually pre-4th), and peak is 30-60 min after dose infused (usually post-3rd).

In critically ill patients, check peak level after the first dose as volume of distribution and renal function may change rapidly.

Serious

  • Erythema multiforme
  • Erythroderma
  • Stevens-Johnson syndrome
  • Toxic epidermal necrolysis
  • Ototoxicity
  • Nephrotoxicity

Increased nephrotoxicity:

  • Amphotericin B
  • Cyclosporine
  • Cisplatin
  • NSAIDS
  • Contrast dye
  • Vancomycin

  • Furosemide - increased ototoxicity

  • Neuromuscular blockade agents - respiratory paralysis

Antimicrobial class: Aminoglycoside

Pregnancy category: D

Average serum half life: 3 hours

Urine penetration: Therapeutic

Lung penetration: Therapeutic

CSF penetration: Poor

Biliary penetration: Moderate

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.