tobramycin (Nebcin, Tobrex)
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Introduction
Tradename: Nebcin.
Indications
- bacterial infections due to susceptible organisms
- Pseudomonas aeruginosa infection
- non-pseudomonal enteric bacillus more susceptible to tobramycin than gentamicin bases on antibiotic sensitivity
- lower respiratory tract infections
- CNS infections
- intra-abdominal infections
- skin infection
- osteomyelitis
- urinary tract infections
- empiric therapy in patients with cystic fibrosis & immunocompromised patients
- empiric therapy for fever of unknown origin[8]
- empiric therapy for febrile neutropenia[8]
- topical agent use to treat superficial ophthalmic infections
Dosage
Adults: 1.0-1.7 mg/kg IV/IM every 8 hours.
Children: 2-2.5 mg/kg every 8 hours.
Injection: (sulfate) 10 mg/mL (2 mL), 40 mg/mL (2 mL)
- handheld inhaler containing a powder formulation of tobramycin, to treat P aeruginosa infections in cystic fibrosis[7]
Ophthalmic agent: Tradename: Tobrex.
Ointment: (ophthalmic) 0.3% (3.5 g)
Solution: (ophthalmic) 0.3% (5 mL)
Dosage adjustment in renal failure
Table
| creatinine clearance | dosage |
|---|---|
| > 50-90 mL/min | 60-90% every 8-12 hours |
| 10-50 mL/min* | 30-70% every 12 hours |
| < 10 mL/min | 20-30% every 24-48 hours |
| > 80 mL/min | 5.1 mg/kg every 24 hours |
| 60-80 mL/min | 4 mg/kg every 24 hours |
| 40-60 mL/min | 3.5 mg/kg every 24 hours |
| 30-40 mL/min | 2.5 mg/kg every 24 hours |
| 20-30 mL/min | 4 mg/kg every 48 hours |
| 10-20 mL/min | 3 mg/kg every 48 hours |
| < 10 mL/min# | 2 mg/kg every 48 hours |
* same dose for continuous arteriovenous hemofiltration
# 2.5 mg/kg after hemodialysis
Pharmacokinetics
elimination via kidney
1/2life = 2-3 hours
protein binding = <5 % negligible
elimination by hemodialysis = +
elimination by peritoneal dialysis = +/-
Monitor
Antimicrobial activity
- Enterococcus faecalis (synergy with penicillins)
- Staphylococcus aureus (MSSA)
- Staphylococcus epidermidis (+/-)
- Neisseria gonorrhoeae
- Moraxella catarrhalis
- Haemophilus influenzae
- Escherichia coli
- Klebsiella species
- Enterobacter species
- Serratia marcescens
- Proteus vulgaris
- Proteus mirabilis
- Acinetobacter species
- Pseudomonas aeruginosa*
- Yersinia enterocolitica
- Providencia[8]
- Citrobacter[8]
* more active than gentamicin against Pseudomonas aeruginosa.
Adverse effects
- not common (1-10%)
- uncommon (< 1%)
- rash, drug fever, headache, paresthesia, tremor, nausea/vomiting, eosinophilia, arthralgia, anemia, hypotension, dyspnea, drowsiness, weakness, lacrimation, itching, edema of the eyelid, keratitis *ototoxicity (auditory & vestibular)
- tinnitus
- vestibular toxicity may occur up to 2-3 months after stopping drug
Laboratory
- specimen: serum, plasma (EDTA, heparin)
- methods: RIA, MB, HPLC, GLC, REA, EIA, FPIA
- see tobramycin in serum or plasma
More general terms
More specific terms
Additional terms
Component of
References
- ↑ The Pharmacological Basis of Therapeutics, 9th ed. Gilman et al, eds. Permagon Press/McGraw Hill, 1996
- ↑ Harrison's Principles of Internal Medicine, 13th ed. Companion Handbook. Isselbacher et al (eds), McGraw-Hill Inc. NY, 1995, pg 163
- ↑ Sanford Guide to antimicrobial therapy 1997, 2001
- ↑ Kaiser Permanente Northern California Regional Drug Formulary, 1998
- ↑ Clinical Guide to Laboratory Tests, NW Tietz (ed) 3rd ed, WB Saunders, Philadelpha 1995
- ↑ Department of Veterans Affairs, VA National Formulary
- ↑ 7.0 7.1 FDA News Release: March 22, 2013 FDA approves TOBI Podhaler to treat a type of bacterial lung infection in cystic fibrosis patients. http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm345123.htm
- ↑ 8.0 8.1 8.2 8.3 8.4 8.5 8.6 Deprecated Reference