Tobramycin

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General

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
  • 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

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]

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

See Also

Refereces

  1. Sanford Guide to Antimicrobial Therapy 2014