Difference between revisions of "Tobramycin"

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==General==
 
==General==
*Type:  
+
*Type: [[Aminoglycoside]]
*Dosage Forms: IV  
+
*Dosage Forms: IV
*Common Trade Names:
+
*Common Trade Names: Tobrex
* Nephro- and oto- toxic; can precipitate [[myasthenia gravis]] crisis
 
  
 
==Adult Dosing==
 
==Adult Dosing==
CrCl > 80: 1 - 1.7 mg/kg iv q 8 h.
+
===[[Infection]], bacterial===
CrCl 80-50: q 8 - 12 h.
+
*1-1.7 mg/kg IM/IV q8h
 +
*For extended interval dosing:
 +
**5-7 mg/kg IV q24h
 +
===[[Pneumonia]], Hospital-acquired===
 +
*5-7 mg/kg IV q24h x7 days
 +
===Respiratory infections, [[Cystic fibrosis]] pts===
 +
*10-12 mg/kg IV q24h
 +
*Alt: 2.5-3.5 mg/kg IV q8h
 +
===[[Endocarditis]], Gram positive synergy===
 +
*3 mg/kg IV q24h for at least 2 weeks as part of multi-drug regimen
  
 
==Pediatric Dosing==
 
==Pediatric Dosing==
 +
===[[Infection]], bacterial===
 +
*<8 days old
 +
**2 mg/kg IV/IM q12h
 +
*>8 days old
 +
**2-2.5 mg/kg IV/IM q8h
 +
===Respiratory infections, [[Cystic fibrosis]] pts===
 +
*>1 mo
 +
**10-12 mg/kg IV q24h
 +
===Febrile [[neutropenia]], post-stem cell transplant===
 +
*<5 yo
 +
**9 mg/kg IV q 24h
 +
*5-11 yo
 +
**8 mg/kg IV q24h
 +
*12+ yo
 +
**7 mg/kg IV q24h
 +
===[[Endocarditis]], Gram positive synergy===
 +
*3-6 mg/kg IV divided q8h as part of multi-drug regimen
  
 
==Special Populations==
 
==Special Populations==
*[[Drug Ratings in Pregnancy|Pregnancy Rating]]:
+
*[[Drug Ratings in Pregnancy|Pregnancy Rating]]: C
*Lactation:
+
*Lactation: May use, no known risk based on drug properties
 
*Renal Dosing
 
*Renal Dosing
 
**Adult
 
**Adult
***CrCl 50-10: 1 - 1.7 mg/kg iv q 12- 48 hrs
+
***CrCl 50-70: Give q8-24h
***CrCl < 10: > 1 - 1.7 mg/kg iv  q 48, dose on peak/trough levels
+
***CrCl 10-50: Give q24-48h
***Hemodialysis: 1 mg/kg after dialysis
+
***CrCl <10: Give q48-72h
 
+
***HD: Give 50% usual dose after dialysis
 +
***PD: Give supplement
 
**Pediatric
 
**Pediatric
 +
***CrCl 30-50: Give q12-18h
 +
***CrCl 10-29: Give q18-24h
 +
***CrCl <10: Give q48-72h
 +
***HD/PD: 2 mg/kg x1 then adjust dose based on serum
 
*Hepatic Dosing
 
*Hepatic Dosing
 
**Adult
 
**Adult
 +
***Not defined
 
**Pediatric
 
**Pediatric
 +
***Not defined
  
 
==Contraindications==
 
==Contraindications==
 
*Allergy to class/drug
 
*Allergy to class/drug
 +
*Caution:
 +
**Hypersensitivity to sulfites
 +
**Renal Impairment
 +
**Dehydration
 +
**Concurrent nephrotoxic/ototoxic agent
 +
**Impaired auditory/vestibular fxn
 +
**Neuromuscular dz
 +
**Prolonged use
  
 
==Adverse Reactions==
 
==Adverse Reactions==
 
===Serious===
 
===Serious===
 +
*Ototoxicity, auditory or vestibular
 +
*Nephrotoxicity, Neurotoxicity
 +
*Neuromuscular blockaed
 +
*Superinfection
 +
*C. Diff associated [[diarrhea]]
 +
*[[Anaphylaxis]]
 +
*Hypersensitivity rxn
 +
*Exfoliative Dermatitis
 +
*Toxic epidermal necrolysis, [[Stevens-Johnson Syndrome]]
 +
*Erythema multiforme
  
 
===Common===
 
===Common===
 +
*BUN, Cr elevation
 +
*[[Dizziness]], [[vertigo]]
 +
*[[Tinnitus]], hearing loss
 +
*Injection site rxn
  
 
==Pharmacology==
 
==Pharmacology==
*Half-life:  
+
*Half-life: 2h
*Metabolism:  
+
*Metabolism: Minimal to none
*Excretion:  
+
*Excretion: Renal (100% unchanged)
*Mechanism of Action:
+
*Mechanism of Action: Binds to bacterial 30S ribosomal subunit, inhibiting protein synthesis
  
 
==[[Antibiotic Sensitivities]]<ref>Sanford Guide to Antimicrobial Therapy 2014</ref>==
 
==[[Antibiotic Sensitivities]]<ref>Sanford Guide to Antimicrobial Therapy 2014</ref>==
Line 160: Line 214:
 
===Key===
 
===Key===
 
{{Template:Antibacterial Spectra Key}}
 
{{Template:Antibacterial Spectra Key}}
 +
 
==See Also==
 
==See Also==
  
==Source==
+
==References==
 
 
 
<references/>
 
<references/>
  
 
[[Category:Pharmacology]]
 
[[Category:Pharmacology]]
 +
[[Category:ID]]

Latest revision as of 23:04, 23 September 2019

General

Adult Dosing

Infection, bacterial

  • 1-1.7 mg/kg IM/IV q8h
  • For extended interval dosing:
    • 5-7 mg/kg IV q24h

Pneumonia, Hospital-acquired

  • 5-7 mg/kg IV q24h x7 days

Respiratory infections, Cystic fibrosis pts

  • 10-12 mg/kg IV q24h
  • Alt: 2.5-3.5 mg/kg IV q8h

Endocarditis, Gram positive synergy

  • 3 mg/kg IV q24h for at least 2 weeks as part of multi-drug regimen

Pediatric Dosing

Infection, bacterial

  • <8 days old
    • 2 mg/kg IV/IM q12h
  • >8 days old
    • 2-2.5 mg/kg IV/IM q8h

Respiratory infections, Cystic fibrosis pts

  • >1 mo
    • 10-12 mg/kg IV q24h

Febrile neutropenia, post-stem cell transplant

  • <5 yo
    • 9 mg/kg IV q 24h
  • 5-11 yo
    • 8 mg/kg IV q24h
  • 12+ yo
    • 7 mg/kg IV q24h

Endocarditis, Gram positive synergy

  • 3-6 mg/kg IV divided q8h as part of multi-drug regimen

Special Populations

  • Pregnancy Rating: C
  • Lactation: May use, no known risk based on drug properties
  • Renal Dosing
    • Adult
      • CrCl 50-70: Give q8-24h
      • CrCl 10-50: Give q24-48h
      • CrCl <10: Give q48-72h
      • HD: Give 50% usual dose after dialysis
      • PD: Give supplement
    • Pediatric
      • CrCl 30-50: Give q12-18h
      • CrCl 10-29: Give q18-24h
      • CrCl <10: Give q48-72h
      • HD/PD: 2 mg/kg x1 then adjust dose based on serum
  • Hepatic Dosing
    • Adult
      • Not defined
    • Pediatric
      • Not defined

Contraindications

  • Allergy to class/drug
  • Caution:
    • Hypersensitivity to sulfites
    • Renal Impairment
    • Dehydration
    • Concurrent nephrotoxic/ototoxic agent
    • Impaired auditory/vestibular fxn
    • Neuromuscular dz
    • Prolonged use

Adverse Reactions

Serious

  • Ototoxicity, auditory or vestibular
  • Nephrotoxicity, Neurotoxicity
  • Neuromuscular blockaed
  • Superinfection
  • C. Diff associated diarrhea
  • Anaphylaxis
  • Hypersensitivity rxn
  • Exfoliative Dermatitis
  • Toxic epidermal necrolysis, Stevens-Johnson Syndrome
  • Erythema multiforme

Common

Pharmacology

  • Half-life: 2h
  • Metabolism: Minimal to none
  • Excretion: Renal (100% unchanged)
  • Mechanism of Action: Binds to bacterial 30S ribosomal subunit, inhibiting protein synthesis

Antibiotic Sensitivities[1]

Group Organism Sensitivity
Gram Positive Strep. Group A, B, C, G R
Strep. Pneumoniae R
Viridans strep X1
Strep. anginosus gp X1
Enterococcus faecalis S
Enterococcus faecium R
MSSA S
MRSA R
CA-MRSA X1
Staph. Epidermidis I
C. jeikeium R
L. monocytogenes S
Gram Negatives N. gonorrhoeae R
N. meningitidis R
Moraxella catarrhalis S
H. influenzae S
E. coli S
Klebsiella sp S
E. coli/Klebsiella ESBL+ S
E coli/Klebsiella KPC+ R
Enterobacter sp, AmpC neg S
Enterobacter sp, AmpC pos S
Serratia sp X1
Serratia marcescens S
Salmonella sp X1
Shigella sp S
Proteus mirabilis X1
Proteus vulgaris S
Providencia sp. X1
Morganella sp. X1
Citrobacter freundii X1
Citrobacter diversus X1
Citrobacter sp. X1
Aeromonas sp X1
Acinetobacter sp. R
Pseudomonas aeruginosa S
Burkholderia cepacia R
Stenotrophomonas maltophilia R
Yersinia enterocolitica S
Francisella tularensis S
Brucella sp. S+'
Legionella sp. X1
Pasteurella multocida X1
Haemophilus ducreyi X1
Vibrio vulnificus I
Misc Chlamydophila sp R
Mycoplasm pneumoniae R
Rickettsia sp R
Mycobacterium avium X1
Anaerobes Actinomyces R
Bacteroides fragilis R
Prevotella melaninogenica R
Clostridium difficile R
Clostridium (not difficile) X1
Fusobacterium necrophorum R
Peptostreptococcus sp. R

Key

  • S susceptible/sensitive (usually)
  • I intermediate (variably susceptible/resistant)
  • R resistant (or not effective clinically)
  • S+ synergistic with cell wall antibiotics
  • U sensitive for UTI only (non systemic infection)
  • X1 no data
  • X2 active in vitro, but not used clinically
  • X3 active in vitro, but not clinically effective for Group A strep pharyngitis or infections due to E. faecalis
  • X4 active in vitro, but not clinically effective for strep pneumonia

See Also

References

  1. Sanford Guide to Antimicrobial Therapy 2014