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an aminoglycosideantibiotic produced by Streptomyces tenebrarius and used topically as the base to treat external infections of the eye, by oral inhalation to treat Pseudomonas aeruginosa infections in patients with cystic fibrosis, and intramuscularly or intravenously as the sulfate salt to treat a wide variety of infections.


Aktob, Apo-Tobramycin, PMS-Tobramycin, TOBI, Tobrex

tobramycin sulfate

Therapeutic class: Anti-infective

Pregnancy risk category B (inhalation, ophthalmic), D (parenteral)

FDA Box Warning

The following boxed warnings apply to parenteral administration only:

When giving drug by injection, observe patient closely for potential ototoxicity and nephrotoxicity. Rarely, nephrotoxicity doesn't emerge until first few days after therapy ends.

Neurotoxicity, manifested as both auditory and vestibular ototoxicity, can occur. Auditory changes are irreversible and usually bilateral. Eighth-nerve impairment and nephrotoxicity also may develop, mainly in patients with preexisting renal damage and in those with normal renal function who receive drug for longer periods or in higher doses than those recommended. Other neurotoxicity manifestations may include numbness, skin tingling, muscle twitching, and seizures. Risk of drug-induced hearing loss increases with degree of exposure to high peak or high trough drug blood levels. Patients who develop cochlear damage may lack symptoms during therapy to warn of eighth-nerve toxicity, and partial or total irreversible bilateral deafness may continue to develop after withdrawal.

Monitor renal and eighth-nerve function closely in patients with known or suspected renal impairment and in those whose renal functional initially is normal but who develop signs of renal dysfunction during therapy. Monitor peak and trough drug blood levels periodically during therapy; avoid levels above 12 mcg. Rising trough levels (above 2 mcg) may indicate tissue accumulation. Such accumulation, excessive peak levels, advanced age, and cumulative dose may contribute to ototoxicity and nephrotoxicity. Examine urine for decreased specific gravity and increased protein, cells, and casts. Measure blood urea nitrogen (BUN), serum creatinine, and creatinine clearance periodically. When feasible, obtain serial audiograms. Evidence of impairment of renal, vestibular, or auditory function warrants drug withdrawal or dosage adjustment.

Avoid concurrent or sequential use of other neurotoxic or nephrotoxic antibiotics, especially other aminoglycosides (such as amikacin, gentamicin, kanamycin, neomycin, and streptomycin), cephaloridine, cisplatin, colistin, polymyxin B, vancomycin, and viomycin. Advanced age and dehydration also increase risk.

Don't give concurrently with potent diuretics (such as furosemide and ethacrynic acid), because these drugs are also ototoxic. Also, I.V. diuretics may increase tobramycin toxicity by altering antibiotic serum and tissue levels.

Use drug cautiously in premature infants and neonates.

Drug may harm fetus when given to pregnant women.


Interferes with protein synthesis in bacterial cell by binding to 30S ribosomal subunit


Injection: 10 mg/ml, 40 mg/ml, 1.2-g vial

Nebulizer solution: 300 mg/5 ml in 5-ml ampule

Ophthalmic ointment: 0.3%

Ophthalmic solution: 0.3%

Pediatric solution for injection: 20 mg/2 ml

Premixed I.V. solution: 60 mg in 50 ml normal saline, 80 mg in 100 ml normal saline

Indications and dosages

Serious infections caused by susceptible organisms

Adults: 3 mg/kg/day I.V. or I.M. in evenly divided doses q 8 hours. For life-threatening infections, may increase up to 5 mg/kg/day I.V. or I.M. in three or four evenly divided doses, then reduce to 3 mg/kg/day as soon as possible.

Children older than 1 week: 6 to 7.5 mg/kg/day in three or four evenly divided doses, such as 2 to 2.5 mg/kg I.V. or I.M. q 8 hours or 1.5 to 1.9 mg/kg I.V. or I.M. q 6 hours

Neonates less than 1 week old: Up to 4 mg/kg/day I.V. or I.M. in evenly divided doses q 12 hours

Pseudomonas aeruginosa in cystic fibrosis patients

Adults and children older than age 6: 300 mg inhalation b.i.d. (preferably q 12 hours but no less than 6 hours apart) for 28 days, then off for 28 days; then repeat cycle

Ocular infections caused by susceptible organisms

Adults and children: For mild to moderate infections, apply a ribbon of ophthalmic ointment (approximately 1 cm) to infected eye two or three times daily, or instill one to two drops of ophthalmic solution into infected eye q 4 hours. For severe infections, apply ophthalmic ointment q 3 to 4 hours or instill two drops of ophthalmic solution into infected eye q 30 to 60 minutes; decrease dosing frequency when improvement occurs. Therapy should continue for at least 48 hours after infection is under control.

Dosage adjustment

• Renal impairment


• Hypersensitivity to drug, other aminoglycosides, bisulfites (with some products), or benzyl alcohol (in neonates, with some products)


Use cautiously in:

• renal or hearing impairment, neuromuscular diseases, obesity

• elderly patients

• pregnant or breastfeeding patients

• neonates and premature infants.


• Know that premixed I.V. solution is ready to use and requires no further dilution. Don't mix with other drugs.

Don't use flexible container in series connections because of risk of air embolism.

• Dilute I.V. dose from vials in 50 to 100 ml of normal saline solution or dextrose 5% in water. For child, smaller volumes are needed.

• Infuse over at least 30 minutes. Flush line after administration.

• Give cephalosporins or penicillin, if ordered, 1 hour before or after tobramycin.

• Give inhalation doses by nebulizer over 10 to 15 minutes.

Adverse reactions

CNS: confusion, lethargy, headache, delirium, dizziness, vertigo

EENT: eye stinging (with ophthalmic form), ototoxicity, hearing loss, roaring in ears, tinnitus

GI: nausea, vomiting, diarrhea, stomatitis

GU: proteinuria, oliguria, nephrotoxicity

Hematologic: anemia, eosinophilia, leukocytosis, leukopenia, thrombocytopenia, granulocytopenia

Metabolic: hypocalcemia, hyponatremia, hypokalemia, hypomagnesemia

Musculoskeletal: muscle weakness

Respiratory: apnea

Skin: rash, urticaria, itching

Other: superinfection, fever, pain and irritation at injection site


Drug-drug. Cephalosporins, vancomycin: increased risk of nephrotoxicity

Dimenhydrinate: masking of ototoxicity symptoms

General anesthetics, neuromuscular blockers: increased neuromuscular blockade and respiratory depression

Indomethacin: increased tobramycin trough and peak levels

Loop diuretics: increased risk of ototoxicity

Penicillins: physical incompatibility, tobramycin inactivation when mixed in same I.V. solution

Polypeptide anti-infectives: increased risk of respiratory paralysis and renal dysfunction

Drug-diagnostic tests. Alanine aminotransferase, aspartate aminotransferase, bilirubin, BUN, creatinine, lactate dehydrogenase, nonprotein nitrogen, urine protein: increased levels

Calcium, granulocytes, hemoglobin, magnesium, platelets, potassium, sodium, white blood cells: decreased levels

Patient monitoring

• Draw sample for peak drug level 1 hour after I.M. or 30 minutes after I.V. administration. Draw sample for trough level just before next dose.

• Assess liver and kidney function tests.

• Monitor CBC with white cell differential.

• Closely monitor patient's hearing.

Patient teaching

Tell patient drug may cause hearing impairment and other serious adverse reactions, such as unusual bleeding or bruising. Instruct him to report these reactions at once.

• Advise patient to report new signs or symptoms of infection.

• With inhalation form, teach patient how to use nebulizer. Instruct him to administer dose over 10 to 15 minutes by breathing normally through mouthpiece while sitting or standing. Remind him to use only the hand-held nebulizer and compressor originally dispensed with drug. Advise him to use a nose clip to help him breathe through his mouth. If he uses other inhaled drugs, instruct him to take tobramycin last.

• Teach patient proper use of eye drops. Caution him not to touch dropper to eye or any other surface.

• As appropriate, review all other significant and life-threatening adverse reactions and interactions, especially those related to the drugs and tests mentioned above.


Nebcin® A broad-spectrum aminoglycoside antibiotic effective against many gram-negative bacteria, in particular, Pseudomonas infections, unresponsiveness to penicillins or cephalosporins Adverse effects Ototoxicity, neurotoxicity, nephrotoxicity. See Therapeutic drug monitoring.


An antibiotic drug similar in use to Gentamicin, but useful in the treatment of gentamicin-resistant infections. A brand name is Nebcin.


1. Pertaining to the ability to destroy or inhibit other living organisms.
2. A substance derived from a mould or bacterium, or produced synthetically, that destroys (bactericidal) or inhibits the growth (bacteriostatic) of other microorganisms and is thus used to treat infections. Some substances have a narrow spectrum of activity whereas others act against a wide range of both gram-positive and gram-negative organisms (broad-spectrum antibiotics). Antibiotics can be classified into several groups according to their mode of action on or within bacteria: (1) Drugs inhibiting bacterial cell wall synthesis, such as bacitracin, vancomycin and the β-lactams based agents (e.g. penicillin, cephalosporins (e.g. ceftazidime, ceftriaxone, cefuroxime). (2) Drugs affecting the bacterial cytoplasmic membrane, such as polymyxin B sulfate and gramicidin. (3) Drugs inhibiting bacterial protein synthesis, such as aminoglycosides (e.g. amikacin sulfate, framycetin sulfate, gentamicin, neomycin sulfate and tobramycin), tetracyclines, macrolides (e.g. erythromycin and azithromycin) and chloramphenicol. (4) Drugs inhibiting the intermediate metabolism of bacteria, such as sulfonamides (e.g. sulfacetamide sodium) and trimethoprim. (5) Drugs inhibiting bacterial DNA synthesis, such as nalixidic acid and fluoroquinolones (e.g. ciprofloxacin, levofloxacin, moxifloxacin, norfloxacin and ofloxacin). (6) Other antibiotics such as fusidic acid, the diamidines, such as propamidine isethionate and dibrompropamidine. Syn. antibacterial. See antiinflammatory drug; fusidic acid.
References in periodicals archive ?
In a Danish cohort [8] 40% of patients with an average of 20 aminoglycoside courses were reported to have an abnormal GFR, but no correlation (r = 0.11) between GFR and the cumulative tobramycin dose was observed.
(B) Interactions between tobramycin and the 30S ribosome.
In the present study antibiotic sensitivity testing was done by using four antibiotics include Ciprofloxacin, Ofloxacin, Cefixime and Tobramycin and found that Tobramycin (10ug) have higher zone of inhibition as compared to Fluoroquinolones and Cephalosporins which are commonly used for the treatment of urinary tract infection or a number of other bacterial infections.15 From previous studies it was found that Fluoroquinolones have lost their activity against MDR gram negative bacteria and it is very difficult to restore it, however, the use of tobramycin as an adjuvant can help to improve Fluoroquinolones activity.16 The irrational use of these medicines is the leading cause of development of resistance.
"The other issue is that tobramycin can be toxic itself."
Moreover, this gene was present in amikacin and tobramycin resistant isolates at a frequency of 94.73 and 81.81%, respectively, while in susceptible isolates by 33.01, and 22.22% respectively.
Statler, "Determination of tobramycin using high-performance liquid chromatography with pulsed amperometric detection," Journal of Chromatography B: Biomedical Sciences and Applications, vol.
In the following days, he experienced a marked reduction in creatinine to 3.72 mg/dl and tobramycin level to 0.6 mcg/ml upon discharge.
Antimicrobial resistance of Acinetobacter spp taken from wound/decubitus swabs during the study period was almost 100% to all tested antibiotics, except colistin and tobramycin. In the examined period, the susceptibility to colistin was 100% and to tobramycin 30.8%.
was found to be maximum sensitive (Table 3) for Ciprofloxacin (100%) followed by Norfloxacin (85.71%), Tobramycin (85.71%), Ceftriaxone (71.42%), Amikacin (71.42%), Amoxycillin (71.42%), Ampicillin (71.42%) and Enrofloxacin (57.14%) but less sensitive to Neomycin, Streptomycin, Chloramphenicol, Kanamycin, Cefoperazone and Cephalexin.
Between aminoglycosides, tobramycin (TOB) shows excellent in vitro and clinical activities against susceptible strains of E.
Zysolin is a Tobramycin compound, encapsulated in AlphaRx's Nano Drug Delivery Platform, intended for the adjunctive treatment of Gram-negative pneumonia in intubated and mechanically-ventilated patients.
coli susceptible to amikacin, gentamicin, tobramycin, piperacillin/ tazobactam, trimethoprim/ sulfamethoxazole, imipenem, and nitrofurantoin.