II. Indications

  1. Gram Negative Infections
  2. Cystic Fibrosis Respiratory Exacerbation (Pseudomonas coverage)

III. Mechanism

  1. See Aminoglycoside
  2. Bacteriostatic AminoglycosideAntibiotic derived from Streptomyces tenebrarius
  3. Antibiotic coverage includes Pseudomonas

IV. Medications

  1. Intravenous solution for injection
  2. Nebulizer Solutions (Tobi, Kitabis Pak, Bethkis): 300 mg in 4 to 5 ml
  3. Tobi Podhaler: 28 mg capsules for inhalation

V. Dosing: Adult

  1. See Bacterial Conjunctivitis
  2. Gram Negative Infections
    1. Give 3 to 5 mg/kg/day divided every 8 hours IV or IM
  3. Cystic Fibrosis Respiratory Exacerbation
    1. Start 10 mg/kg/day divided every 6 hours (FDA approved)
      1. Further dosing based on target peak 8 to 12 mcg/ml
    2. Start 10 to 12 mg/kg IV every 24 hours (off-label, but preferred by CF foundation)
      1. Further dosing based on target peak 20 to 30 mg/L and trough <1 mg/L
  4. Cystic Fibrosis Respiratory Prophylaxis
    1. Nebulize 300 mg or 4 caps via Tobi Podhaler twice daily in cycles of 28 days on and 28 days off

VI. Dosing: Child

  1. See Bacterial Conjunctivitis
  2. Gram Negative Infections
    1. Age >1 week old: Give 2 to 2.5 mg/kg/day divided every 8 hours IV or IM
    2. Age <1 week old: Give 4 mg/kg/day divided every 12 hours IV or IM
  3. Cystic Fibrosis Respiratory Exacerbation
    1. Start: 10 mg/kg/day divided every 6 hours (FDA approved)
      1. Further dosing based on target peak 8 to 12 mcg/ml
    2. Start 10 to 12 mg/kg IV every 24 hours (off-label, but preferred by CF foundation)
      1. Further dosing based on target peak 20 to 30 mcg/ml and trough <1 mcg/ml
  4. Cystic Fibrosis Respiratory Prophylaxis (age >=6 years old)
    1. Nebulize 300 mg or 4 caps via Tobi Podhaler twice daily in cycles of 28 days on and 28 days off

VII. Pharmacokinetics

  1. See above Cystic Fibrosis dosing for target levels
  2. Target levels for multiple daily dosing (Gram Negative infections)
    1. Peak 5 to 10 mcg/ml
    2. Trough <2 mcg/ml
  3. Target level for single daily dose (Gram Negative infections)
    1. Peak 15 to 20 mcg/ml
    2. Trough <1 mcg/ml

VIII. Adverse Effects

  1. See Aminoglycoside
  2. Aminoglycosides are associated with risk of Ototoxicity and nephrotoxicity (FDA black box warning)
    1. See Aminoglycoside for risk factors

IX. Safety

  1. Pregnancy Category D
  2. Considered safe in Lactation

X. Drug Interactions

  1. Diuretics
    1. Risk of nephrotoxicity

XII. References

  1. Hamilton (2020) Tarascon Pocket Pharmacopoeia
  2. Reyhanoglu (2023) Tobramycin, StatPearls, Treasure Island
    1. https://www.ncbi.nlm.nih.gov/books/NBK551695/

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Related Studies

Cost: Medications

tobramycin (on 7/20/2022 at Medicaid.Gov Survey of pharmacy drug pricing)
TOBRAMYCIN 0.3% EYE DROP Generic $1.43 per ml
TOBRAMYCIN 300 MG/5 ML AMPULE Generic $2.80 per ml
TOBRAMYCIN-DEXAMETH OPHTH SUSP Generic $4.41 per ml
tobrex (on 11/23/2022 at Medicaid.Gov Survey of pharmacy drug pricing)
TOBREX 0.3% EYE OINTMENT $61.86 per gram

Ontology: Tobramycin (C0040341)

Definition (NCI) An aminoglycoside antibiotic derived from Streptomyces tenebrarius with bacteriostatic activity. Following active transport into the cell, tobramycin binds irreversibly to a specific aminoglycoside receptor on the bacterial 30S ribosomal subunit and interferes with the initiation complex between messenger RNA and the 30S subunit, thereby inhibiting initiation of protein synthesis, consequently leading to bacterial cell death. In addition, tobramycin induces misreading of the mRNA template causing incorrect amino acids to be incorporated into the growing polypeptide chain, consequently interfering with protein elongation.
Definition (MSH) An aminoglycoside, broad-spectrum antibiotic produced by Streptomyces tenebrarius. It is effective against gram-negative bacteria, especially the PSEUDOMONAS species. It is a 10% component of the antibiotic complex, NEBRAMYCIN, produced by the same species.
Concepts Antibiotic (T195) , Carbohydrate (T118)
MSH D014031
SnomedCT 321084008, 330397003, 324171003, 373548001, 89695009
LNC LP16294-8, MTHU004270
English Tobramycin, Nebramycin Factor 6, D-Streptamine, O-3-amino-3-deoxy-alpha-D-glucopyranosyl-(1-6)-O-(2,6-diamino-2,3,6-trideoxy-alpha-D-ribo-hexopyranosyl-(1-4))-2-deoxy-, Tobramycin [eye], Tobramycin [systemic], tobramycin, TOBRAMYCIN, Tobramycin [Chemical/Ingredient], tbm, Tobramycin [respiratory use] (product), Tobramycin [eye] (product), Tobramycin [systemic] (product), Tobramycin [respiratory use], Nebramycin factor VI, Tobramycin product, Tobramycin (product), Tobramycin (substance), TBM, Tobramycin [eye] (substance), Tobramycin [respiratory use] (substance), Tobramycin [systemic] (substance)
Swedish Tobramycin
Czech tobramycin
Finnish Tobramysiini
Russian TOBRAMITSIN, NEOBRAMITSINA FAKTOR6, NEBRAMITSIN, FAKTOR 6, НЕБРАМИЦИН, ФАКТОР 6, НЕОБРАМИЦИНА ФАКТОР6, ТОБРАМИЦИН
Japanese ネブラマイシンファクター6, ネブラマイシン第6因子, トブラマイシン
Polish Tobramycyna
Spanish tobramicina [uso oftálmico] (producto), tobramicina [uso sistémico], tobramicina [uso respiratorio] (producto), tobramicina [uso respiratorio], tobramicina [uso sistémico] (producto), tobramicina [uso oftálmico], tobramicina (producto), tobramicina (sustancia), tobramicina [oftálmica] (producto), tobramicina [oftálmica], tobramicina [sistémica] (producto), tobramicina [sistémica], tobramicina, Tobramicina, Factor 6 de la Nebramicina
French Tobramycine
German Nebramycin Faktor 6, Tobramycin
Italian Tobramicina
Portuguese Nebramicina Fator 6, Tobramicina