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Tobramycin

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Tobramycin, Tobi, Tobrex, Bethkis, Kitabis Pak

  • See Also
  1. Aminoglycoside
  2. Cystic Fibrosis
  3. Bacterial Conjunctivitis
  • Indications
  1. Gram Negative Infections
  2. Cystic Fibrosis Respiratory Exacerbation (Pseudomonas coverage)
  • Mechanism
  1. See Aminoglycoside
  2. Bacteriostatic AminoglycosideAntibiotic derived from Streptomyces tenebrarius
  3. Antibiotic coverage includes Pseudomonas
  • Medications
  1. Intravenous solution for injection
  2. Nebulizer Solutions (Tobi, Kitabis Pak, Bethkis): 300 mg in 4 to 5 ml
  3. Tobi Podhaler: 28 mg capsules for inhalation
  • Dosing
  • Adult
  1. See Bacterial Conjunctivitis
  2. Gram Negative Infections
    1. Give 3 to 5 mg/kg/day divided every 8 hours IV or IM
  3. Cystic Fibrosis Respiratory Exacerbation
    1. Start 10 mg/kg/day divided every 6 hours (FDA approved)
      1. Further dosing based on target peak 8 to 12 mcg/ml
    2. Start 10 to 12 mg/kg IV every 24 hours (off-label, but preferred by CF foundation)
      1. Further dosing based on target peak 20 to 30 mg/L and trough <1 mg/L
  4. Cystic Fibrosis Respiratory Prophylaxis
    1. Nebulize 300 mg or 4 caps via Tobi Podhaler twice daily in cycles of 28 days on and 28 days off
  • Dosing
  • Child
  1. See Bacterial Conjunctivitis
  2. Gram Negative Infections
    1. Age >1 week old: Give 2 to 2.5 mg/kg/day divided every 8 hours IV or IM
    2. Age <1 week old: Give 4 mg/kg/day divided every 12 hours IV or IM
  3. Cystic Fibrosis Respiratory Exacerbation
    1. Start: 10 mg/kg/day divided every 6 hours (FDA approved)
      1. Further dosing based on target peak 8 to 12 mcg/ml
    2. Start 10 to 12 mg/kg IV every 24 hours (off-label, but preferred by CF foundation)
      1. Further dosing based on target peak 20 to 30 mcg/ml and trough <1 mcg/ml
  4. Cystic Fibrosis Respiratory Prophylaxis (age >=6 years old)
    1. Nebulize 300 mg or 4 caps via Tobi Podhaler twice daily in cycles of 28 days on and 28 days off
  • Pharmacokinetics
  1. See above Cystic Fibrosis dosing for target levels
  2. Target levels for multiple daily dosing (Gram Negative infections)
    1. Peak 5 to 10 mcg/ml
    2. Trough <2 mcg/ml
  3. Target level for single daily dose (Gram Negative infections)
    1. Peak 15 to 20 mcg/ml
    2. Trough <1 mcg/ml
  • Adverse Effects
  1. See Aminoglycoside
  2. Aminoglycosides are associated with risk of Ototoxicity and nephrotoxicity (FDA black box warning)
    1. See Aminoglycoside for risk factors
  • Safety
  1. Pregnancy Category D
  2. Considered safe in Lactation
  • Drug Interactions
  1. Diuretics
    1. Risk of nephrotoxicity
  • Resources
  1. Tobramycin Poweder for Injection (DailyMed)
    1. https://dailymed.nlm.nih.gov/dailymed/lookup.cfm?setid=d62ff359-912b-4be1-9fc2-2dde8777eefb
  2. Tobramycin Ophthalmic Solution (DailyMed)
    1. https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=c91db5e0-f6b8-40d7-b307-b24073b9705e
  3. Tobi Podhaler (DailyMed)
    1. https://dailymed.nlm.nih.gov/dailymed/lookup.cfm?setid=c4b5bb1f-e158-4ac1-9c35-e98a416c743a
  4. Tobramycin Nebulizer Solution (DailyMed)
    1. https://dailymed.nlm.nih.gov/dailymed/lookup.cfm?setid=6a3c3871-1d3a-44d6-8be3-526b30123ef7
  • References
  1. Hamilton (2020) Tarascon Pocket Pharmacopoeia
  2. Reyhanoglu (2023) Tobramycin, StatPearls, Treasure Island
    1. https://www.ncbi.nlm.nih.gov/books/NBK551695/