Pseudomonal and other gram negative infections, inhaled form used in cystic fibrosis
Monitor creatinine at least weekly and more often if levels are elevated or other signs of renal dysfunction arise. Discontinue if any signs of ototoxicity (tinnitus, fullness in ears, dizziness).
Serum Level Monitoring for EXTENDED Interval Dosing, Pediatrics: Obtain trough concentrations when treatment is anticipated to be longer than 48 hours. Measure trough level 1 hour prior to second dose.Target trough: less than 1 microgram/mL.If trough is less than 1 microgram/mL, continue current dose and repeat trough every 7 days. If indicated, may measure peak level with first dose 30 minutes following 30 minute IV infusion. Target peak: 15-25 micrograms/mL.
Serum Level Monitoring for EXTENDED Interval Dosing, Neonates: Check tobramycin level at 22 hours post start of infusion, regardless of the dosing interval that the patient is started on for all patients with an anticipated tobramycin treatment greater than 48 hours. For patients less than or equal to 7 days of age in whom anticipated tobramycin treatment duration is less than or equal to 48 hours (i.e. clinical suspicion for early-onset sepsis is low), only order 22 hour tobramycin level if any or the following criteria apply:
Adjust dosing interval based on the 22-hour level drawn with the first dose by referring to the information below or in discussion with the pharmacist.
Serum Level Monitoring for EXTENDED Interval Dosing, Women's Health: For anticipated duration of therapy more than 48 hours monitor serum tobramycin levels as follows. Measure level 18 hours after start of infusion (based on 30 minute infusion) to assess for adequate clearance. Target 18 hour level: 1 microgram/mL or less. If 18 hour level is within desired range, repeat every 4 days or sooner if clinically necessary.
Antimicrobial class: Aminoglycoside
Average serum half life: Neonates:
Infants: 4 ± 1 hour. Children: 2 ± 1 hour. Adolescents: 1.5 ± 1 hour Adults: IV: 1-2 hours; directly dependent upon glomerular filtration rate Adults with impaired renal function: 5- 70 hours
Route of Elimination: With normal renal function, 93% of dose excreted in urine within 24 hours