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
Increased nephrotoxicity:
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.