What follows is the old fashioned way to dose tobramycin, useful for endocarditis. For once a day dosing and rational click here.
CrCl > 80: 1 - 1.7 mg/kg iv q 8 h.
CrCl 80-50: q 8 - 12 h.
CrCl 50-10: q 1 2- 48 h.
CrCl < 10: > q 48, dose on levels.
Hemodialysis: 1 mg/kg after dialysis.
Important side effects
Nephro and oto toxicity. Neuromuscular blockade.
Important drug interactions
Bumetanide, capreomycin, carboplatin, cidofovir, cisplatin, cyclosporine, ethacrynic acid, furosemide, indomethacin, magnesium, nondepolarizing neuromuscular blockers, piretanide, succinylcholine, tacrolimus, vancomycin.
Rants and Screeds
With the exception of endocarditis, I can think of no reason that a patient should be on long term parenteral tobramycin, except of course, you like your patients deaf and on dialysis.
Classically want a peak of 4 - 10 ug/ml, a trough of < 2 ug/ml.
By the way, aminolgycosides should probably be used as monotherapy only for urinary tract infections (PubMed).
Treatment of choice
If you are going to use an aminoglycoside against Pseudomonas, give this one (local susceptibilities allowing). It has better MIC's than gentamicin.
Acinetobacter infections, Appendicitis, bone cement beads, bronchiectasis, Cellulitis, Cystic fibrosis, Endocarditis treatment, Enterobacter, Intra abdominal infections, Meningitis,Neutropenic fever, ocular infection, ophthalmic infection - external, Osteomyelitis, Peritonitis, Pneumonia, Proteus, Providencia stuartii, Pseudomonas, reconstructive surgery, Sepsis, surgical prophylaxis - abdominal, tracheobronchitis, UTI, Yersinia enterocolitica infections.
Consider inhaled tobramycin for cystic fibrosis pneumonia.
Don't use for
Relevant links to my Medscape blog