Adult Dosing
Bacterial infections
- 3 mg/kg/day IV/IM divided q8 hrs; up to 5 mg/kg/day may be given in life-threatening infections. Adjust dose based on blood levels and toxicity.
- MAX: 5 mg/kg/day
Severe cystic fibrosis
- 10 mg/kg/day IV/IM divided q6 hrs; monitor serum drug levels and adjust accordingly
Bronchiectasis [Not FDA Approved]
- 1-1.7 mg/kg/dose IV q8 hrs or 5-7 mg/kg/dose IV q24 hrs; monitor serum drug levels and adjust accordingly
Pharyngitis (Acute) [Non-FDA Approved]
- 1-1.7 mg/kg/dose IV q8 hrs or 5-7 mg/kg/dose IV q24 hrs; monitor serum drug levels and adjust accordingly
Pediatric Dosing
Bacterial infections
- < = 1 wk: 4 mg/kg/day IV/IM divided q12 hrs
- > 1wk: 6-7.5 mg/kg/day IV/IM divided q6-8 hrs
- Adjust dose based on blood levels and toxicity.
Bronchiectasis [Not FDA Approved]
- >1 mos: 6–10 mg/kg/day IV/IM divided q8 hrs
Pharyngitis (Acute) [Non-FDA Approved]
- >1 mos: 6-10 mg/kg/day IV/IM divided q8 hrs
[Outline]
- Tobramycin causes nephrotoxicity and neurotoxicity, risk factors include concomitant neurotoxic and/or nephrotoxic agents, diuretics, advancing age, and dehydration
- Obtain culture and susceptibility tests before starting therapy; use only to treat or prevent infections that are proven or strongly suspected to be caused by susceptible bacteria
- Anaphylactic symptoms and life-threatening or less severe asthmatic episodes may occur in certain susceptible patients
- Serious allergic reactions; fatal cases reported. Anaphylaxis and dermatologic reactions including exfoliative dermatitis, toxic epidermal necrolysis, erythema multiforme, and Stevens - Johnson syndrome may occur
- Superinfection may occur, initiate appropriate therapy
- Cross-sensitivity among aminoglycosides may occur
- Higher doses are recommended in patients with cystic fibrosis, neutropenia, or burns
- Monitor BUN/Cr at baseline, then periodically; serum drug levels (after 2-3 doses; then q3-4 days); urinalysis
- Perform audiometry for high risk pts, planned prolonged therapy, if high serum levels or signs of hearing impairment
- Prolonged serum concentrations >12 mcg/mL should be avoided. Rising trough levels (>2 mcg/mL) may indicate tissue accumulation
- Therapeutic Peak Levels: 8-10 mg/L in pulmonary infections, neutropenia, osteomyelitis, and severe sepsis; 6-10 mg/L for other infections
- Therapeutic Trough Levels: <2 mg/L
Cautions: Use cautiously in
- Renal impairment
- Auditory impairment
- Impaired vestibular function
- Concurrent ototoxic agents
- Concurrent neurotoxic agents
- Neuromuscular disease
- Electrolyte disturbances
- Prolonged use
- High dose therapy
- Elderly patients
- Obesity
Pregnancy Category:D
Breastfeeding: Safety unknown; poorly excreted in breastmilk. Monitor infants for adverse events on gastrointestinal flora, such as diarrhea, candidiasis (e.g., thrush, diaper rash) or rarely, blood in the stool. This drug should be used with caution in nursing mothers based upon LactMed database (available at http://toxnet.nlm.nih.gov/cgi-bin/sis/htmlgen?LACT last accessed 4 September 2010)
