Tobramycin - Renal - Adult Dosing

  • Use ideal body weight for dosing in most cases

  • Use adjusted body weight for obese patients (BMI≥ 30kg/m²)

  • Aminoglycoside dosing & monitoring per pharmacy available. Order in CareConnect

CrCl > 60 mL/min

5-7 mg/kg IV Q24h

CrCl 40 - 60 mL/min

5-7 mg/kg IV Q36h

CrCl 20 - 39 mL/min

5-7 mg/kg IV Q48h

CrCl < 20 mL/min

Call pharmacy

Note

Extended dosing allows for high peak to MIC ratios potentially improving efficacy and reducing the risk of nephro- and ototoxicity. An extended-interval level drawn between 6-14 hours (after the start of the infusion) is recommended anytime after the first dose. Peak levels are not necessary and trough levels should be undetectable. Call pharmacy for assessment of aminoglycoside levels.

CrCl > 60 mL/min

1-2 mg/kg/dose IV Q8h-Q12h

CrCl 40 - 60 mL/min

1.2-1.5 mg/kg/dose IV Q12h-Q24h

CrCl 20 - 39 mL/min

1.5 mg/kg/dose IV Q24-Q48h

CrCl < 20 mL/min

1-1.5 mg/kg/dose IV Q48h-Q72h

Note

Target tobramycin levels: PEAK = 5-10 mg/L and TROUGH = < 1 mg/L. Peak levels should be drawn ½ hour following a ½ hour infusion. Trough levels should be obtained prior to the fourth dose of the regimen. Traditional dosing is the preferred method for Gram-positive synergy dosing in infective endocarditis. For patients with CrCl > 60 ml/min for whom synergy dosing is required, recommend 1 mg/kg/dose IV Q8h. Gram-positive synergy PEAK = 3-4 mcg/mL and TROUGH = undetectable.

HD

3 mg/kg IV x1 then 1-3 mg/kg IV Post HD

CRRT

5 mg/kg IV x1 then 3–5 mg/kg IV Q24-48h