Tobramycin Sulphate

Indications

Tobramycin Sulphate is used for: Cystic fibrosis

Adult Dose

Inhalation Cystic fibrosis Indicated for management Pseudomonas aeruginosa in patients with cystic fibrosis Adult: One single-use ampoule (300 mg) 12 hrly, inhaled from a suitable nebuliser for 28 days, then stop for 28 days and repeat in cycles of 28 days as needed.

Child Dose

Inhalation Cystic fibrosis Indicated for management Pseudomonas aeruginosa in patients with cystic fibrosis Child: >6 yr : 300 mg 12 hrly, inhaled from a suitable nebuliser for 28 days, then stop for 28 days and repeat in cycles of 28 days as needed.

Renal Dose

Renal impairment: Dosage adjustment needed.

Administration

Contra Indications

Hypersensitivity to aminoglycosides; pregnancy.

Precautions

Preexisting renal and auditory or vestibular impairment; dehydration; neuromuscular blockade, muscular disorders (e.g. myasthenia gravis, parkinsonism); neonates; elderly; lactation. Lactation: Unknown whether inhaled tobramycin will reach sufficient concentration to be distributed in breast milk; because of the potential for ototoxicity and nephrotoxicity in infants, a decision should be made whether to terminate breastfeeding or discontinue inhaled tobramycin

Pregnancy-Lactation

Interactions

Increased nephrotoxicity or ototoxicity with etacrynic acid, furosemide, other aminoglycosides, cefalotin, cisplatin, vancomycin, piperacillin, ciclosporin, amphotericin B. Decrease serum tobramycin levels with miconazole. Potentially Fatal: Increased neuromuscular-blocking activity with magnesium and other neuromuscular-blocking agents.

Adverse Effects

Side effects of Tobramycin Sulphate : >10% Voice alteration (12.8%) 1-10% Myalgia (4.7%),Laryngitis (4.3%),Tinnitus (3%),Epistaxis (3%)

Mechanism of Action

Tobramycin acts by binding to 30S ribosomal subunits thus interfering with bacterial protein synthesis. It is active against many aerobic gram-negative bacteria and some aerobic gram-positive bacteria but inactive against Chlamydia, fungi, viruses, and most anaerobic bacteria.