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