View source for Tobramycin

==General==
*Type: [[Is DrugClass::Aminoglycoside]]
*Dosage Forms: IV
*Common Trade Names: Tobrex

==Adult Dosing==
===[[Infection]], bacterial===
*1-1.7 mg/kg IM/IV q8h
*For extended interval dosing:
**5-7 mg/kg IV q24h
===[[Pneumonia]], Hospital-acquired===
*5-7 mg/kg IV q24h x7 days
===Respiratory infections, [[Cystic fibrosis]] pts===
*10-12 mg/kg IV q24h
*Alt: 2.5-3.5 mg/kg IV q8h
===[[Endocarditis]], Gram positive synergy===
*3 mg/kg IV q24h for at least 2 weeks as part of multi-drug regimen

===Indications by Disease===
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==Pediatric Dosing==
===Indications by Disease===
{{#ask: [[Has DrugName::Tobramycin]] [[Has Population::Pediatric]]
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===[[Infection]], bacterial===
*<8 days old
**2 mg/kg IV/IM q12h
*>8 days old
**2-2.5 mg/kg IV/IM q8h
===Respiratory infections, [[Cystic fibrosis]] pts===
*>1 mo
**10-12 mg/kg IV q24h
===Febrile [[neutropenia]], post-stem cell transplant===
*<5 yo
**9 mg/kg IV q 24h
*5-11 yo
**8 mg/kg IV q24h
*12+ yo
**7 mg/kg IV q24h
===[[Endocarditis]], Gram positive synergy===
*3-6 mg/kg IV divided q8h as part of multi-drug regimen

==Special Populations==
*[[Drug Ratings in Pregnancy|Pregnancy Rating]]: C
*Lactation: May use, no known risk based on drug properties
*Renal Dosing
**Adult
***CrCl 50-70: Give q8-24h
***CrCl 10-50: Give q24-48h
***CrCl <10: Give q48-72h
***HD: Give 50% usual dose after dialysis
***PD: Give supplement
**Pediatric
***CrCl 30-50: Give q12-18h
***CrCl 10-29: Give q18-24h
***CrCl <10: Give q48-72h
***HD/PD: 2 mg/kg x1 then adjust dose based on serum
*Hepatic Dosing
**Adult
***Not defined
**Pediatric
***Not defined

==Contraindications==
*Allergy to class/drug
*Caution:
**Hypersensitivity to sulfites
**Renal Impairment
**Dehydration
**Concurrent nephrotoxic/ototoxic agent
**Impaired auditory/vestibular fxn
**Neuromuscular dz
**Prolonged use

==Adverse Reactions==
===Serious===
*Ototoxicity, auditory or vestibular
*Nephrotoxicity, Neurotoxicity
*Neuromuscular blockaed
*Superinfection
*C. Diff associated [[diarrhea]]
*[[Anaphylaxis]]
*Hypersensitivity rxn
*Exfoliative Dermatitis
*Toxic epidermal necrolysis, [[Stevens-Johnson Syndrome]]
*Erythema multiforme

===Common===
*BUN, Cr elevation
*[[Dizziness]], [[vertigo]]
*[[Tinnitus]], hearing loss
*Injection site rxn

==Pharmacology==
*Half-life: 2h
*Metabolism: Minimal to none
*Excretion: Renal (100% unchanged)
*Mechanism of Action: Binds to bacterial 30S ribosomal subunit, inhibiting protein synthesis

==[[Antibiotic Sensitivities]]<ref>Sanford Guide to Antimicrobial Therapy 2014</ref>==
{| class="wikitable"
| align="center" style="background:#f0f0f0;"|'''Group'''
| align="center" style="background:#f0f0f0;"|'''Organism'''
| align="center" style="background:#f0f0f0;"|'''Sensitivity'''
|-
| Gram Positive||[[Strep. Group A, B, C, G]]||R
|-
| ||[[Strep. Pneumoniae]]||R
|-
| ||[[Viridans strep]]||X1
|-
| ||Strep. anginosus gp||X1
|-
| ||[[Enterococcus faecalis]]||'''S'''
|-
| ||[[Enterococcus faecium]]||R
|-
| ||[[MSSA]]||'''S'''
|-
| ||[[MRSA]]||R
|-
| ||[[CA-MRSA]]||X1
|-
| ||[[Staph. Epidermidis]]||I
|-
| ||[[C. jeikeium]]||R
|-
| ||[[L. monocytogenes]]||'''S'''
|-
| Gram Negatives||[[N. gonorrhoeae]]||R
|-
| ||[[N. meningitidis]]||R
|-
| ||[[Moraxella catarrhalis]]||'''S'''
|-
| ||[[H. influenzae]]||'''S'''
|-
| ||[[E. coli]]||'''S'''
|-
| ||[[Klebsiella]] sp||'''S'''
|-
| ||E. coli/Klebsiella ESBL+||'''S'''
|-
| ||E coli/Klebsiella KPC+||R
|-
| ||[[Enterobacter]] sp, AmpC neg||'''S'''
|-
| ||[[Enterobacter]] sp, AmpC pos||'''S'''
|-
| ||[[Serratia]] sp||X1
|-
| ||Serratia marcescens||'''S'''
|-
| ||[[Salmonella]] sp||X1
|-
| ||[[Shigella]] sp||'''S'''
|-
| ||[[Proteus mirabilis]]||X1
|-
| ||[[Proteus vulgaris]]||'''S'''
|-
| ||[[Providencia sp.]]||X1
|-
| ||[[Morganella sp.]]||X1
|-
| ||[[Citrobacter freundii]]||X1
|-
| ||[[Citrobacter diversus]]||X1
|-
| ||[[Citrobacter sp.]]||X1
|-
| ||[[Aeromonas sp]]||X1
|-
| ||[[Acinetobacter sp.]]||R
|-
| ||[[Pseudomonas aeruginosa]]||'''S'''
|-
| ||[[Burkholderia cepacia]]||R
|-
| ||[[Stenotrophomonas maltophilia]]||R
|-
| ||[[Yersinia enterocolitica]]||'''S'''
|-
| ||[[Francisella tularensis]]||'''S'''
|-
| ||[[Brucella sp.]]||''S+'''
|-
| ||[[Legionella sp.]]||X1
|-
| ||[[Pasteurella multocida]]||X1
|-
| ||[[Haemophilus ducreyi]]||X1
|-
| ||[[Vibrio vulnificus]]||I
|-
| Misc||[[Chlamydophila sp]]||R
|-
| ||[[Mycoplasm pneumoniae]]||R
|-
| ||[[Rickettsia sp]]||R
|-
| ||[[Mycobacterium avium]]||X1
|-
| Anaerobes||[[Actinomyces]]||R
|-
| ||[[Bacteroides fragilis]]||R
|-
| ||[[Prevotella melaninogenica]]||R
|-
| ||[[Clostridium difficile]]||R
|-
| ||[[Clostridium (not difficile)]]||X1
|-
| ||[[Fusobacterium necrophorum]]||R
|-
| ||[[Peptostreptococcus sp.]]||R
|}

===Key===
{{Template:Antibacterial Spectra Key}}

==See Also==

==References==
<references/>

[[Category:Pharmacology]]
[[Category:ID]]