Tobramycin

General

• Type: aminoglycoside
• Dosage Forms: IV, oral inhalation, opthalmic drops
• Common Trade Names:
• Nephro- and oto- toxic; can precipitate myasthenia gravis crisis

Adult Dosing

CrCl > 80: 1 - 1.7 mg/kg iv q 8 h. CrCl 80-50: q 8 - 12 h.

Special Populations

• Pregnancy Rating:
• Lactation:
• Renal Dosing
  • Adult
    • CrCl 50-10: 1 - 1.7 mg/kg iv q 12- 48 hrs
    • CrCl < 10: > 1 - 1.7 mg/kg iv q 48, dose on peak/trough levels
    • Hemodialysis: 1 mg/kg after dialysis

• • Pediatric
• Hepatic Dosing
  • Adult
  • Pediatric

Contraindications

• Allergy to class/drug

Pharmacology

• Half-life:
• Metabolism:
• Excretion: renal
• Mechanism of Action:

Antibiotic Sensitivities

Group	Organism	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

• S susceptible/sensitive (usually)
• I intermediate (variably susceptible/resistant)
• R resistant (or not effective clinically)
• S+ synergistic with cell wall antibiotics
• U sensitive for UTI only (non systemic infection)
• X1 no data
• X2 active in vitro, but not used clinically
• X3 active in vitro, but not clinically effective for Group A strep pharyngitis or infections due to E. faecalis
• X4 active in vitro, but not clinically effective for strep pneumonia