II. Indications
- Gram Negative Infections
- Cystic Fibrosis Respiratory Exacerbation (Pseudomonas coverage)
III. Mechanism
- See Aminoglycoside
- Bacteriostatic Aminoglycoside antibiotic derived from Streptomyces tenebrarius
- Antibiotic coverage includes Pseudomonas
IV. Medications
- Intravenous solution for injection
- Nebulizer Solutions (Tobi, Kitabis Pak, Bethkis): 300 mg in 4 to 5 ml
- Tobi Podhaler: 28 mg capsules for inhalation
V. Dosing: Adult
- See Bacterial Conjunctivitis
-
Gram Negative Infections
- Give 3 to 5 mg/kg/day divided every 8 hours IV or IM
-
Cystic Fibrosis Respiratory Exacerbation
- Start 10 mg/kg/day divided every 6 hours (FDA approved)
- Further dosing based on target peak 8 to 12 mcg/ml
- Start 10 to 12 mg/kg IV every 24 hours (off-label, but preferred by CF foundation)
- Further dosing based on target peak 20 to 30 mg/L and trough <1 mg/L
- Start 10 mg/kg/day divided every 6 hours (FDA approved)
-
Cystic Fibrosis Respiratory Prophylaxis
- Nebulize 300 mg or 4 caps via Tobi Podhaler twice daily in cycles of 28 days on and 28 days off
VI. Dosing: Child
- See Bacterial Conjunctivitis
-
Gram Negative Infections
- Age >1 week old: Give 2 to 2.5 mg/kg/day divided every 8 hours IV or IM
- Age <1 week old: Give 4 mg/kg/day divided every 12 hours IV or IM
-
Cystic Fibrosis Respiratory Exacerbation
- Start: 10 mg/kg/day divided every 6 hours (FDA approved)
- Further dosing based on target peak 8 to 12 mcg/ml
- Start 10 to 12 mg/kg IV every 24 hours (off-label, but preferred by CF foundation)
- Further dosing based on target peak 20 to 30 mcg/ml and trough <1 mcg/ml
- Start: 10 mg/kg/day divided every 6 hours (FDA approved)
-
Cystic Fibrosis Respiratory Prophylaxis (age >=6 years old)
- Nebulize 300 mg or 4 caps via Tobi Podhaler twice daily in cycles of 28 days on and 28 days off
VII. Pharmacokinetics
- See above Cystic Fibrosis dosing for target levels
- Target levels for multiple daily dosing (Gram Negative infections)
- Peak 5 to 10 mcg/ml
- Trough <2 mcg/ml
- Target level for single daily dose (Gram Negative infections)
- Peak 15 to 20 mcg/ml
- Trough <1 mcg/ml
VIII. Adverse Effects
- See Aminoglycoside
-
Aminoglycosides are associated with risk of Ototoxicity and nephrotoxicity (FDA black box warning)
- See Aminoglycoside for risk factors
IX. Safety
- Pregnancy Category D
- Considered safe in Lactation
X. Drug Interactions
-
Diuretics
- Risk of nephrotoxicity
XI. Resources
- Tobramycin Poweder for Injection (DailyMed)
- Tobramycin Ophthalmic Solution (DailyMed)
- Tobi Podhaler (DailyMed)
- Tobramycin Nebulizer Solution (DailyMed)
XII. References
- Hamilton (2020) Tarascon Pocket Pharmacopoeia
- Reyhanoglu (2023) Tobramycin, StatPearls, Treasure Island
Images: Related links to external sites (from Bing)
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