Tobramycin

CLINICAL USE

Antibacterial agent

DOSE IN NORMAL RENAL FUNCTION

IM/IV: 3 mg/kg/day in 3 divided doses; maximum 5 mg/kg/day in 3–4 divided doses Urinary tract infections: 2–3 mg/kg daily as a single dose (IM)

PHARMACOKINETICS

Molecular weight : 467.5

%Protein binding : <5

%Excreted unchanged in urine : 90

Volume of distribution (L/kg) : 0.25

half-life – normal/ESRD (hrs) : 2–3/5–70

DOSE IN RENAL IMPAIRMENT

GFR (mL/MIN)

20 to 50 : Give 1–2 mg/kg then dose according to serum levels

10 to 20 : Give 1 mg/kg then dose according to serum levels

<10 : Give 1 mg/kg then dose according to serum levels

DOSE IN PATIENTS UNDERGOING RENAL REPLACEMENT THERAPIES

CAPD : Dialysed. Dose as in GFR <10 mL/min

HD : Dialysed. Dose as in GFR <10 mL/min

HDF/high flux : Dialysed. Dose as in GFR <10 mL/min

CAV/VVHD : Dialysed. 1.5–2 mg/kg every 24 hours and monitor levels1

IMPORTANT DRUG INTERACTIONS

Potentially hazardous interactions with other drugs Botulinum toxin: neuromuscular block enhanced – risk of toxicity

Ciclosporin: increased risk of nephrotoxicity Cytotoxics: increased risk of nephrotoxicity and possibly of ototoxicity with platinum compounds

Diuretics: increased risk of ototoxicity with loop diuretics Muscle relaxants: enhanced effect of non-depolarising muscle relaxants and suxamethonium Parasympathomimetics: antagonism of effect of neostigmine and pyridostigmine

Tacrolimus: increased risk of nephrotoxicity

ADMINISTRATION

Reconstition

Add to 50–100 mL sodium chloride 0.9% or glucose 5% for

IV infusion

Route

IV, IM, IP, nebulised

Rate of Administration

20–60 minutes

Comments

Plasma concentrations should be measured frequently; trough ≤2 mg/L, peak 60 minutes post dose ≤10 mg/L; avoid prolonged peaks above 12 mg/L

OTHER INFORMATION

25–70% can be removed by haemodialysis Used via nebuliser for chronic pulmonary Pseudomonas aeruginosa infection in cystic fibrosis: 300 mg every 12 hours for 28 days, repeat after 28 days Can be used for peritonitis at doses of 6 mg/L intraperitoneally

See how to identify renal failure stages according to GFR calculation

See how to diagnose irreversible renal disease

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