Tobramycin

What is Tobramycin

Tobramycin is an aminoglycoside antibiotic obtained from cultures of Streptomyces tenebrarius.

It is most active against aerobic gram-negative rods and, in combination with other antibiotics, is used to treat Staphylococcus aureus and certain species of Streptococcus.

Tobramycin and some other aminoglycosides are used in combination with a penicillin for the treatment of endocarditis. Tobramycin also possesses activity against certain Mycobacterium species but is not active against any anaerobic bacteria.

Some studies suggest that it is less nephrotoxic than gentamicin; however, a difference in incidence of nephrotoxicity has not been firmly established. Tobramycin injection was approved by the FDA in June 1975; tobramycin ophthalmic was approved prior to 1982.

An aerosolized dosage form (TOBI) for the management of cystic fibrosis patients with Pseudomonas infection was given orphan drug designation and was approved by the FDA in December 1997.

Subsequently, two other inhaled formulations have received FDA approval for the management of cystic fibrosis patients >= 6 years old with Pseudomonas aeruginosa, Bethkis (an orally inhaled nebulized solution) approved October 2012 and TOBI Podhaler (an orally inhaled powder) approved March 2013.

Indications

  1. Acinetobacter calcoaceticus
  2. Acinetobacter sp.
  3. Aeromonas sp.
  4. Bacillus anthracis
  5. bacteremia
  6. bacterial conjunctivitis
  7. blepharitis
  8. blepharoconjunctivitis
  9. bone and joint infections
  10. burn wound infection
  11. cellulitis
  12. Citrobacter sp.
  13. community-acquired pneumonia
  14. cystic fibrosis
  15. dacryocystitis
  16. endocarditis
  17. Enterobacter sp.
  18. Enterococcus sp.
  19. Escherichia coli
  20. febrile neutropenia
  21. Haemophilus aegyptius
  22. Haemophilus influenzae (beta-lactamase negative)
  23. Haemophilus influenzae (beta-lactamase positive)
  24. infectious arthritis
  25. intraabdominal infections
  26. keratitis
  27. keratoconjunctivitis
  28. Klebsiella aerogenes
  29. Klebsiella pneumoniae
  30. Klebsiella sp.
  31. lower respiratory tract infections
  32. meibomianitis
  33. meningitis
  34. Moraxella lacunata
  35. Morganella morganii
  36. Neisseria sp.
  37. nosocomial pneumonia
  38. osteomyelitis
  39. peritonitis
  40. pneumonia
  41. Proteus mirabilis
  42. Proteus vulgaris
  43. Providencia sp.
  44. Pseudomonas aeruginosa
  45. Salmonella sp.
  46. sepsis
  47. Serratia sp.
  48. Shigella sp.
  49. skin and skin structure infections
  50. Staphylococcus aureus (MSSA)
  51. Staphylococcus epidermidis
  52. Staphylococcus sp.
  53. Streptococcus pneumoniae
  54. Streptococcus sp.
  55. surgical infection prophylaxis
  56. urinary tract infection (UTI)
  57. ventriculitis

Side Effects

  1. abdominal pain
  2. anaphylactoid reactions
  3. anemia
  4. anorexia
  5. aphonia
  6. asthenia
  7. ataxia
  8. azotemia
  9. back pain
  10. bronchospasm
  11. bullous rash
  12. chest pain (unspecified)
  13. confusion
  14. cough
  15. cylindruria
  16. diarrhea
  17. dizziness
  18. dysgeusia
  19. dysphonia
  20. dyspnea
  21. elevated hepatic enzymes
  22. eosinophilia
  23. epistaxis
  24. erythema
  25. erythema multiforme
  26. exfoliative dermatitis
  27. fever
  28. headache
  29. hearing loss
  30. hemoptysis
  31. hyperbilirubinemia
  32. hyperventilation
  33. hypocalcemia
  34. hypokalemia
  35. hypomagnesemia
  36. hyponatremia
  37. hyposthenuria
  38. impaired wound healing
  39. injection site reaction
  40. laryngitis
  41. lethargy
  42. leukocytosis
  43. leukopenia
  44. malaise
  45. myalgia
  46. myasthenia
  47. nasal congestion
  48. nausea
  49. nephrotoxicity
  50. neurotoxicity
  51. ocular irritation
  52. ocular pruritus
  53. otalgia
  54. ototoxicity
  55. pharyngitis
  56. proteinuria
  57. pruritus
  58. pseudomembranous colitis
  59. pyuria
  60. rash
  61. renal tubular acidosis (RTA)
  62. renal tubular necrosis
  63. rhinitis
  64. seizures
  65. sinusitis
  66. Stevens-Johnson syndrome
  67. superinfection
  68. throat irritation
  69. thrombocytopenia
  70. tinnitus
  71. toxic epidermal necrolysis
  72. urticaria
  73. vertigo
  74. vitamin B12 deficiency
  75. vitamin B6 deficiency
  76. vomiting
  77. weakness
  78. weight loss
  79. wheezing

Monitoring Parameters

  • audiometry
  • serum aminoglycoside concentrations
  • serum creatinine/BUN

Contraindications

  • acute bronchospasm
  • aminoglycoside hypersensitivity
  • botulism
  • breast-feeding
  • colitis
  • corneal abrasion
  • dehydration
  • diabetes mellitus
  • diarrhea
  • electrolyte imbalance
  • geriatric
  • GI disease
  • hearing impairment
  • inflammatory bowel disease
  • myasthenia gravis
  • neonates
  • nephrotoxicity
  • neuromuscular disease
  • neurotoxicity
  • ototoxicity
  • parkinsonism
  • pregnancy
  • premature neonates
  • pseudomembranous colitis
  • renal disease
  • renal failure
  • renal impairment
  • respiratory depression
  • respiratory insufficiency
  • serious rash
  • tinnitus
  • ulcerative colitis

Interactions

  • Acetaminophen; Aspirin, ASA; Caffeine
  • Acetaminophen; Caffeine; Magnesium Salicylate; Phenyltoloxamine
  • Acetaminophen; Caffeine; Phenyltoloxamine; Salicylamide
  • Acetaminophen; Chlorpheniramine; Dextromethorphan; Phenylephrine
  • Acetaminophen; Chlorpheniramine; Dextromethorphan; Pseudoephedrine
  • Acetaminophen; Chlorpheniramine; Phenylephrine; Phenyltoloxamine
  • Acetaminophen; Diphenhydramine
  • Acyclovir
  • Adefovir
  • Aldesleukin, IL-2
  • Aminosalicylate sodium, Aminosalicylic acid
  • Amobarbital
  • Amphotericin B
  • Amphotericin B cholesteryl sulfate complex (ABCD)
  • Amphotericin B lipid complex (ABLC)
  • Amphotericin B liposomal (LAmB)
  • Aprotinin
  • Aspirin, ASA
  • Aspirin, ASA; Butalbital; Caffeine
  • Aspirin, ASA; Butalbital; Caffeine; Codeine
  • Aspirin, ASA; Caffeine; Dihydrocodeine
  • Aspirin, ASA; Caffeine; Orphenadrine
  • Aspirin, ASA; Carisoprodol
  • Aspirin, ASA; Carisoprodol; Codeine
  • Aspirin, ASA; Citric Acid; Sodium Bicarbonate
  • Aspirin, ASA; Dipyridamole
  • Aspirin, ASA; Omeprazole
  • Aspirin, ASA; Oxycodone
  • Aspirin, ASA; Pravastatin
  • Atracurium
  • Atropine; Benzoic Acid; Hyoscyamine; Methenamine; Methylene Blue; Phenyl Salicylate
  • Atropine; Hyoscyamine; Phenobarbital; Scopolamine
  • Azelastine; Fluticasone
  • Bacitracin
  • Beclomethasone
  • Benzoic Acid; Hyoscyamine; Methenamine; Methylene Blue; Phenyl Salicylate
  • Betamethasone
  • Bictegravir; Emtricitabine; Tenofovir Alafenamide
  • Bismuth Subsalicylate
  • Bismuth Subsalicylate; Metronidazole; Tetracycline
  • Bleomycin
  • Botulinum Toxins
  • Budesonide
  • Budesonide; Formoterol
  • Bumetanide
  • Capreomycin
  • Carbetapentane; Chlorpheniramine
  • Carbetapentane; Chlorpheniramine; Phenylephrine
  • Carbetapentane; Diphenhydramine; Phenylephrine
  • Carboplatin
  • Cefepime
  • Cefotaxime
  • Cefotetan
  • Cefoxitin
  • Cefprozil
  • Ceftazidime
  • Ceftazidime; Avibactam
  • Ceftizoxime
  • Cefuroxime
  • Chlorpheniramine
  • Chlorpheniramine; Codeine
  • Chlorpheniramine; Dextromethorphan
  • Chlorpheniramine; Dextromethorphan; Phenylephrine
  • Chlorpheniramine; Dihydrocodeine; Phenylephrine
  • Chlorpheniramine; Dihydrocodeine; Pseudoephedrine
  • Chlorpheniramine; Guaifenesin; Hydrocodone; Pseudoephedrine
  • Chlorpheniramine; Hydrocodone
  • Chlorpheniramine; Hydrocodone; Phenylephrine
  • Chlorpheniramine; Hydrocodone; Pseudoephedrine
  • Chlorpheniramine; Phenylephrine
  • Chlorpheniramine; Pseudoephedrine
  • Chlorpromazine
  • Choline Salicylate; Magnesium Salicylate
  • Ciclesonide
  • Cidofovir
  • Cisatracurium
  • Cisplatin
  • Clofarabine
  • Codeine; Phenylephrine; Promethazine
  • Codeine; Promethazine
  • Corticosteroids
  • Corticotropin, ACTH
  • Cortisone
  • Cyclizine
  • Cyclosporine
  • Daptomycin
  • Darunavir; Cobicistat; Emtricitabine; Tenofovir alafenamide
  • Deferasirox
  • Deflazacort
  • Dexamethasone
  • Dextromethorphan; Diphenhydramine; Phenylephrine
  • Dextromethorphan; Promethazine
  • Dimenhydrinate
  • Diphenhydramine
  • Diphenhydramine; Hydrocodone; Phenylephrine
  • Diphenhydramine; Ibuprofen
  • Diphenhydramine; Naproxen
  • Diphenhydramine; Phenylephrine
  • Doravirine; Lamivudine; Tenofovir disoproxil fumarate
  • Doxacurium
  • Efavirenz; Emtricitabine; Tenofovir
  • Efavirenz; Lamivudine; Tenofovir Disoproxil Fumarate
  • Elvitegravir; Cobicistat; Emtricitabine; Tenofovir Alafenamide
  • Elvitegravir; Cobicistat; Emtricitabine; Tenofovir Disoproxil Fumarate
  • Emtricitabine
  • Emtricitabine; Rilpivirine; Tenofovir alafenamide
  • Emtricitabine; Rilpivirine; Tenofovir disoproxil fumarate
  • Emtricitabine; Tenofovir alafenamide
  • Emtricitabine; Tenofovir disoproxil fumarate
  • Entecavir
  • Ethacrynic Acid
  • Fludrocortisone
  • Flunisolide
  • Fluphenazine
  • Fluticasone
  • Fluticasone; Salmeterol
  • Fluticasone; Umeclidinium; Vilanterol
  • Fluticasone; Vilanterol
  • Formoterol; Mometasone
  • Foscarnet
  • Furosemide
  • Gallium
  • Gallium Ga 68 Dotatate
  • Ganciclovir
  • General anesthetics
  • Ginger, Zingiber officinale
  • Gold
  • Hyaluronidase, Recombinant; Immune Globulin
  • Hydrocortisone
  • Hyoscyamine; Methenamine; Methylene Blue; Phenyl Salicylate; Sodium Biphosphate
  • Ibandronate
  • Ibuprofen lysine
  • Immune Globulin IV, IVIG, IGIV
  • Inotersen
  • Iohexol
  • Iopamidol
  • Iopromide
  • Ioversol
  • Isosulfan Blue
  • Lamivudine; Tenofovir Disoproxil Fumarate
  • Lithium
  • Magnesium Salicylate
  • Mannitol
  • Meclizine
  • Meperidine; Promethazine
  • Mesoridazine
  • Methohexital
  • Methylprednisolone
  • Mivacurium
  • Mometasone
  • Mycophenolate
  • Neuromuscular blockers
  • Non-Ionic Contrast Media
  • Nonsteroidal antiinflammatory drugs
  • Oral Contraceptives
  • Pamidronate
  • Pancuronium
  • Pentamidine
  • Perphenazine
  • Perphenazine; Amitriptyline
  • Phenylephrine; Promethazine
  • Polymyxin B
  • Polymyxins
  • Prednisolone
  • Prednisone
  • Promethazine
  • Pyridostigmine
  • Rapacuronium
  • Rocuronium
  • Salicylates
  • Salsalate
  • Scopolamine
  • Sodium picosulfate; Magnesium oxide; Anhydrous citric acid
  • Streptozocin
  • Succinylcholine
  • Surfactants
  • Tacrolimus
  • Telavancin
  • Tenofovir Alafenamide
  • Tenofovir, PMPA
  • Thioridazine
  • Tolvaptan
  • Torsemide
  • Triamcinolone
  • Trifluoperazine
  • Trimethobenzamide
  • Tubocurarine
  • Urea
  • Valacyclovir
  • Valganciclovir
  • Vancomycin
  • Vecuronium
  • Warfarin
  • Zalcitabine, ddC
  • Zoledronic Acid
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