Formulary
Tobramycin: Indications, Dosing, Side Effects and Interactions
Tobramycin clinical drug profile including indications, dosing, side effects, cautions and interactions.
MedNext Academy | 7 min read
Tobramycin: Indications, Dosing, Side Effects and Interactions
Tobramycin clinical drug profile including indications, dosing, side effects, cautions and interactions.
Indications and dose
**Local treatment of infections**
- **Child** (To The Eye): 1-17 years Apply twice daily for 6-8 days.
- **Adult** (To The Eye): Apply twice daily for 6-8 days.
**Local treatment of infections (severe infection)**
- **Child** (To The Eye): 1-17 years Apply 4 times a day for first day, then apply twice daily for 5-7 days.
- **Adult** (To The Eye): Apply 4 times a day for first day, then apply twice daily for 5-7 days.
**Septicaemia,Meningitis and other CNS infections,Biliary-tract infection,Acute pyelonephritis or prostatitis,Pneumonia in hospital patients**
- **Adult** (By Intramuscular Injection, Or By Slow Intravenous Injection, Or By Intravenous Infusion): 3 mg/kg daily in 3 divided doses; increased if necessary up to 5 mg/kg daily in 3-4 divided doses, increased dose used in severe infection; dose to be reduced back to 3 mg/kg daily as soon as clinically indicated.
**Urinary-tract infection**
- **Adult** (By Intramuscular Injection): 2-3 mg/kg for 1 dose.
**ChronicPseudomonas aeruginosainfection in patients with cystic fibrosis**
- **Adult** (By Inhalation Of Nebulised Solution): Chronic Pseudomonas aeruginosa infection in patients with cystic fibrosis 300 mg every 12 hours for 28 days, subsequent courses repeated after 28-day interval without tobramycin nebuliser solution.
- **Adult** (By Inhalation Of Powder): 112 mg every 12 hours for 28 days, subsequent courses repeated after 28-day interval without tobramycin inhalation powder.
**Chronic pulmonaryPseudomonas aeruginosainfection in patients with cystic fibrosis**
- **Adult** (By Inhalation Of Nebulised Solution): Chronic pulmonary Pseudomonas aeruginosa infection in patients with cystic fibrosis 170 mg every 12 hours for 28 days, subsequent courses repeated after 28-day interval without tobramycin nebuliser solution.
**Local treatment of infections for tobramycin**
- **Child 1-17 years** (To the eye): Apply twice daily for 6-8 days.
**Local treatment of infections (severe infection) for tobramycin**
- **Child 1-17 years** (To the eye): Apply 4 times a day for first day, then apply twice daily for 5-7 days.
**Chronic Pseudomonas aeruginosa infection in patients with cystic fibrosis for tobramycin**
- **Child 6-17 years** (By inhalation of nebulised solution): 300 mg every 12 hours for 28 days, subsequent courses repeated after 28-day interval without tobramycin nebuliser solution.
- **Child 6-17 years** (By inhalation of powder): 112 mg every 12 hours for 28 days, subsequent courses repeated after 28-day interval without tobramycin inhalation powder.
**Pulmonary infection with Pseudomonas aeruginosa in cystic fibrosis for tobramycin**
- **Child** (By intravenous infusion): Initially 10 mg/kg once daily (max. per dose 660 mg), to be given over 30 minutes, subsequent doses adjusted according to serum-tobramycin concentration.
- **Child** (By slow intravenous injection): Initially 8-10 mg/kg daily in 3 divided doses, to be given as a multiple daily dose regimen over 3-5 minutes, subsequent doses adjusted according to serum-tobramycin concentration.
**Septicaemia, Meningitis and other CNS infections, Biliary-tract infection, Acute pyelonephritis, Pneumonia in hospital patients for tobramycin**
- **Child 1 month-11 years** (By slow intravenous injection): 2-2.5 mg/kg every 8 hours, to be given as a multiple daily dose regimen over 3-5 minutes.
- **Child 12-17 years** (By slow intravenous injection): 1 mg/kg every 8 hours, to be given as a multiple daily dose regimen over 3-5 minutes; increased if necessary up to 5 mg/kg daily in 3-4 divided doses, to be given in severe infections as a multiple daily dose regimen over 3-5 minutes, dose to be reduced back to 3 mg/kg as soon as clinically indicated.
- **Child** (By intravenous infusion): Initially 7 mg/kg, to be given as a once daily dose regimen, subsequent doses adjusted according to serum-tobramycin concentration.
**Neonatal sepsis for tobramycin**
- **Neonate up to 32 weeks corrected gestational age** (By intravenous injection, or by intravenous infusion): 4-5 mg/kg every 36 hours, to be given as an extended interval dose regimen, intravenous injection to be given over 3-5 minutes.
- **Neonate 32 weeks corrected gestational age and above** (By intravenous injection, or by intravenous infusion): 4-5 mg/kg every 24 hours, to be given as an extended interval dose regimen, intravenous injection to be given over 3-5 minutes.
- **Neonate up to 7 days** (By slow intravenous injection, or by intravenous infusion): 2 mg/kg every 12 hours, to be given as a multiple daily dose regimen.
- **Neonate 7 days to 28 days** (By slow intravenous injection, or by intravenous infusion): 2-2.5 mg/kg every 8 hours, to be given as a multiple daily dose regimen.
**Chronic pulmonary Pseudomonas aeruginosa infection in patients with cystic fibrosis for Vantobra nebuliser solution**
- **Child 6-17 years** (By inhalation of nebulised solution): 170 mg every 12 hours for 28 days, subsequent courses repeated after 28-day interval without tobramycin nebuliser solution.
Cautions
For all aminoglycosides (by injection) Auditory disorder; care must be taken with dosage (the main side-effects of the aminoglycosides are dose-related); conditions characterised by muscular weakness (aminoglycosides may impair neuromuscular transmission); if possible, dehydration should be corrected before starting an aminoglycoside; vestibular disorder; whenever possible, parenteral treatment should not exceed 7 days Cautions For tobramycin When used by inhalation Auditory disorder; conditions characterised by muscular weakness (may impair neuromuscular transmission); history of prolonged previous or concomitant intravenous aminoglycosides (increased risk of ototoxicity); renal impairment (limited information available); severe haemoptysis (risk of further haemorrhage); vestibular disorder
Contraindications
For all aminoglycosides (by injection) Myasthenia gravis (aminoglycosides may impair neuromuscular transmission)
Side effects
For all aminoglycosides (by injection) Common or very common Aphonia; appetite decreased; bronchospasm; chest discomfort; cough; diarrhoea; dizziness; dysphonia; fever; haemoptysis; headache; hearing impairment; increased risk of infection; nausea; oropharyngeal pain; renal impairment; skin reactions; taste altered; tinnitus; vomiting Rare or very rare Anaemia; azotaemia; eosinophilia; hypomagnesaemia; paraesthesia Frequency not known Confusion; lethargy; leucopenia; muscle weakness; nephrotoxicity; peripheral neuropathy; thrombocytopenia; vertigo Side-effects, further information Ototoxicity and nephrotoxicity are important side-effects to consider with aminoglycoside therapy. Nephrotoxicity occurs most commonly in patients with renal impairment, who may require reduced doses; monitoring is particularly important in the elderly. Side-effects For tobramycin Common or very common When used by inhalation Malaise; respiratory disorder; sputum discolouration Rare or very rare When used by inhalation Abdominal pain; asthenia; asthma; drowsiness; ear disorder; ear pain; epistaxis; hypoxia; lymphadenopathy; oral ulceration; pain Frequency not known With parenteral use Granulocytopenia; leucocytosis; nerve disorders; urine abnormalities Side-effects, further information Manufacturer advises to monitor serum-tobramycin concentration in patients with known or suspected signs of auditory dysfunction; if ototoxicity develops - discontinue treatment until serum concentration falls below 2 mg/litre. With inhaled use Since systemic absorption can follow inhaled use, also consider the side-effects of systemic aminoglycosides.
Interactions
**Other interactions (5):**
- Some diuretics can enhance aminoglycoside toxicity by altering antibiotic concentrations in serum and tissue.
- Bramitob should not be administered concomitantly with furosemide, ethacrynic acid, urea or intravenous and oral mannitol.
- Other medicinal products that have been reported to increase the potential toxicity of parenterally administered aminoglycosides include: Amphotericin B, cephalotin, ciclosporin, tacrolimus,...
- Anticholinesterases, botulinum toxin: Due to their neuromuscular effects, the combination with tobramycin should be avoided.
- Others: In clinical studies, patients taking nebulised tobramycin concomitantly with dornase alfa, mucolytic, B agonists, inhaled corticosteroids, and other oral or parenteral anti-pseudomonal...
Pregnancy
For all aminoglycosides (by injection) There is a risk of auditory or vestibular nerve damage in the infant when aminoglycosides are used in the second and third trimesters of pregnancy. The risk is greatest with streptomycin. The risk is probably very small with gentamicin and tobramycin, but their use should be avoided unless essential. Monitoring in pregnancy If given during pregnancy, serum-aminoglycoside concentration monitoring is essential.
Renal impairment
For all aminoglycosides (by injection) Aminoglycosides are primarily renally excreted and accumulation can occur in renal impairment (increased risk of ototoxicity and nephrotoxicity)-serum-aminoglycoside concentrations must be frequently monitored in patients with renal impairment. M Dose adjustments Reduce dose and/or increase the dose interval according to impairment (consult product literature). M Renal impairment For tobramycin When used by inhalation: Monitor serum-tobramycin concentration; if nephrotoxicity develops-discontinue treatment until serum concentration falls below 2 mg/litre. M
Medicinal forms
Solution,Powder
Clinical governance
**Author:** MedNext Clinical Team. **Clinical reviewer:** Dr Shameer Deen, MBBS, MS, MRCS. **Sources:** BNF, Indian Pharmacopoeia, CIMS India. **Correction:** Report errors at support@mednext.academy.
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