Drug Index

Tobramycin

 
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Mechanism :

Aminoglycoside antibiotic. It is available as injectable, ointments and ophthalmic solutions.


Indication :

• Gram negative infection: E.coli, Klebsiella, Enterobacter, Serratia, Proteus and Pseudomonas infections

• Cystic fibrosis


Contraindications :

Hypersensitivity to tobramycin and myasthenia gravis is a contraindication to its use. During therapy renal function should be monitored. Dose adjustment is required in impaired renal function. Hearing tests are recommended in cystic fibrosis patients receiving repeated doses of aminoglycosides.


Dosing :

In neonates:

<30 weeks gestation:

<28 days: 2.5 mg/kg/day IV/IM.

>28 days: 3 mg/kg/day IV/IM.

30-36 weeks gestation:

<14 days: 3 mg/kg/day IV/IM.

>14 days: 5 mg/kg/day IV/IM in 2 divided doses.

>37 week gestation:

<7 days: 5 mg/kg/day IV/IM in 2 divided doses.

>7 days: 7.5 mg/kg/day IV/IM in 3 divided doses.

Children:

<5 years: 2.5 mg/kg/dose every 8 hours, IM/IV.

>5 years: 2-2.5 mg/kg/dose every 8 hours, IM/IV.

Pseudomonas aeruginosa in cystic fibrosis:

In children >6 years: 300 mg via nebuliser inhaled twice daily.


Adverse Effect :

Ototoxicity, nephrotoxicity. Bronchospasm, voice alteration, myalgia, laryngitis, epistaxis can occur if nebulised.


Interaction :

Seen mostly with parenteral administration of drug.
Vancomycin, Cephalosporin, Cyclosporine, Furosemide, Cisplatin, Amphotericin: Increases chances of ototoxicity and nephrotoxicity.
Non-Depolarising Muscle Relaxants: Enhances effect.
Neostigmine, Pyridostigmine: Antagonises effect.



Renal Dose :

Dose in Renal Impairment GFR (mL/min)
20-50Give 1–2 mg/kg then dose according to serum levels
10-20Give 1 mg/kg then dose according to serum levels
<10Give 1 mg/kg then dose according to serum levels

Dose in Patients undergoing Renal Replacement Therapies
CAPDDialysed. Dose as in GFR<10 mL/min
HDDialysed. Dose as in GFR<10 mL/min
HDF/High fluxDialysed. Dose as in GFR<10 mL/min
CAV/VVHDDialysed. 1.5–2 mg/kg every 24 hours and monitor levels

Hepatic Dose :

No dose adjustment recommended.
08/03/2020 16:46:12 Tobramycin
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