Tobramycin: Difference between revisions
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==General== | ==General== | ||
*Type: [[ | *Type: [[Aminoglycoside]] | ||
*Dosage Forms: IV | *Dosage Forms: IV | ||
*Common Trade Names: Tobrex | *Common Trade Names: Tobrex | ||
==Adult Dosing== | ==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 | |||
==Pediatric Dosing== | ==Pediatric Dosing== | ||
===[[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== | ==Special Populations== | ||
*[[Drug Ratings in Pregnancy|Pregnancy Rating]]: | *[[Drug Ratings in Pregnancy|Pregnancy Rating]]: C | ||
*Lactation: | *Lactation: May use, no known risk based on drug properties | ||
*Renal Dosing | *Renal Dosing | ||
**Adult | **Adult | ||
***CrCl 50-10: | ***CrCl 50-70: Give q8-24h | ||
***CrCl < 10: | ***CrCl 10-50: Give q24-48h | ||
*** | ***CrCl <10: Give q48-72h | ||
***HD: Give 50% usual dose after dialysis | |||
***PD: Give supplement | |||
**Pediatric | **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 | *Hepatic Dosing | ||
**Adult | **Adult | ||
***Not defined | |||
**Pediatric | **Pediatric | ||
***Not defined | |||
==Contraindications== | ==Contraindications== | ||
*Allergy to class/drug | *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== | ==Adverse Reactions== | ||
===Serious=== | ===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=== | ===Common=== | ||
*BUN, Cr elevation | |||
*[[Dizziness]], [[vertigo]] | |||
*[[Tinnitus]], hearing loss | |||
*Injection site rxn | |||
==Pharmacology== | ==Pharmacology== | ||
*Half-life: | *Half-life: 2h | ||
*Metabolism: | *Metabolism: Minimal to none | ||
*Excretion: | *Excretion: Renal (100% unchanged) | ||
*Mechanism of Action: | *Mechanism of Action: Binds to bacterial 30S ribosomal subunit, inhibiting protein synthesis | ||
==[[Antibiotic Sensitivities]]<ref>Sanford Guide to Antimicrobial Therapy 2014</ref>== | ==[[Antibiotic Sensitivities]]<ref>Sanford Guide to Antimicrobial Therapy 2014</ref>== | ||
Line 163: | Line 217: | ||
==See Also== | ==See Also== | ||
== | ==References== | ||
<references/> | <references/> | ||
[[Category:Pharmacology]] | [[Category:Pharmacology]] | ||
[[Category:ID]] |
Latest revision as of 23:04, 23 September 2019
General
- Type: 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
Pediatric Dosing
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
- 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
- Adult
- Hepatic Dosing
- Adult
- Not defined
- Pediatric
- Not defined
- Adult
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
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[1]
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
See Also
References
- ↑ Sanford Guide to Antimicrobial Therapy 2014