Tobramycin

C. diff Risk

Low

Oral Bioavailability

NA

Approximate Cost

General Information

Common Usage

Pseudomonal and other gram negative infections.

Inhaled form used in cystic fibrosis.

Drug Monitoring

Monitor creatinine at least 3 times/week. Discontinue if any signs of ototoxicity.

Pharmacist will consult, adjust doses and order serum drug levels and renal function monitoring as per MSH Policy.

For indication specific peak and trough target levels, please refer to MSH Aminoglycoside Policy and consult pharmacy.

Adverse Effects

Nephrotoxicity (non-oliguric)

  •  Avoid concomitant nephrotoxins

  •  Less common with once daily dosing

  •  Greater toxicity with longer duration and supratherapeutic trough levels

Vestibulocochlear toxicity

  • Irreversible

  • Require audiology testing if prolonged use

Can exacerbate neuromuscular blockade

  •  Contraindicated in patients with myasthenia gravis.

Major Interactions

Increased nephrotoxicity

  •  Amphotericin B

  •  Cyclosporine

  •  Cisplatin

  •  NSAIDS

  •  Contrast dye

  •  Vancomycin

Increased ototoxicity

  •  Furosemide

Neuromuscular blockade agents - Respiratory paralysis.

Additional Information

Formal audiology assessment if planning to use aminoglycoside for >7d or if symptoms develop.

Inform patient of risk of ototoxicity and to report any symptoms

Pharmacology

Antimicrobial class: Aminoglycoside

Pregnancy category: D

Average serum half life: 3 hours

Biliary penetration: Moderate

CSF penetration: Poor

Lung penetration: Therapeutic

Urine penetration: Therapeutic