Tobramycin
Renal - Adult

Renal - Adult

Notes

  • Tobramycin is the preferred aminoglycoside for organisms with suspected/documented resistance to gentamicin or for non-MDR Pseudomonas
  • Extended Interval dosing is recommended over conventional dosing
    • Exceptions: CrCl<40 ml/min or rapidly declining renal function, ESRD, burns>20%, pregnancy, ascites
  • Use ideal body wt and adjusted body wt in obese patients (BMI≥30)

Dosing

**Extended Interval Dosing (Preferred)**
  • CrCl 40-60 ml/min: 5-7 mg/kg IV Q36-48h
  • CrCl <40 ml/min: Switch to conventional amikacin dosing
**Conventional Dosing**
  • CrCl 40-60 ml/min: 1.2-1.5 mg/kg IV Q12-24h
  • CrCl 20-40 ml/min: 1.5 mg/kg IV Q24h-48h
  • CrCl<20 (ESRD not on HD): 1-1.5 mg/kg IVQ48h-72h
  • Dialysis: 3 mg/kg IV x 1, then 1-3 mg/kg IV post-HD
**CRRT**

Give loading dose of 5 mg/kg, then call pharmacy for assistance

Additional Considerations

  • Recommend to dose per pharmacy. (See HS 1476 policy)
  • Extended interval dosing allows for high peak to MIC ratios potentially improving efficacy and reducing the risk of nephro- and ototoxicity. An extended interval level is drawn 6 to 14h after start of infusion.
  • Conventional dosing levels are drawn 48-72h:

    • Sepsis, PNA, BSI, CNS, Bone & Joint, Febrile Neutropenia Goal Peak 6-10; Goal Trough <1
    • SSTI, Intra-abdominal Goal Peak 5-7; Goal Trough <1
    • Genitourinary, Prophylaxis Goal Peak 3-4; Goal Trough <0.5