Tobramycin injection (Nebcin)

Category:

  • Antibiotic

Description:

  • Aminoglycoside antibiotic

Indications:

  • Bacterial infections (P. aeruginosa, Proteus species (including P. mirabilis), M. morganii, E. coli, P. vulgaris, Klebsiella-Enterobacter-Serratia group, Citrobacter species, Staphylococcus species)

  • Septicemia (P. aeruginosa, E. coli, Klebsiella species)

  • Lower respiratory tract infections (P. aeruginosa, E. coli, Klebsiella species, Enterobacter species, Serratia species, S. aureus)

  • Serious bacterial infections of the CNS (meningitis)

  • Intra-abdominal infections, including peritonitis (, E. coli, Klebsiella species, Enterobacter species)

  • Skin, bone and soft tissue infections (P. aeruginosa, Proteus species, E. coli, Klebsiella species, Enterobacter species, S. aureus)

  • Complicated and recurrent urinary tract infections (P. aeruginosa, Proteus species, E. coli, Klebsiella species, Enterobacter species, Serratia species, Citrobacter species, Providencia species, S. aureus)

  • Cystic fibrosis nebulization therapy (P. aeruginosa)

Contraindications:

  • Generally not indicated for long-term therapy due to nephrotoxocity and ototoxicity

Precautions:

  • Pregnancy category D

  • May cause nephrotoxicity, therefore closely monitor renal function, especially in elderly patients.

  • May cause ototoxicity, therefore monitor hearing

  • Monitor peak and trough serum concentrations

  • In patients with extensive burns, altered pharmacokinetics may alter serum concentrations.

  • May produce hypomagnesemia, especially if poor or restricted diet.

  • Aminoglycosides have neuromuscular blockade activity with a curare-like effect.  Monitor patientís neuromuscular function, especially in patients with myasthenia gravis, parkinsonism or infant botulism.

  • Cystic fibrosis patients may have altered pharmacokinetics, requiring reduced dosages

Adverse Reactions (Side Effects):

  • Central and peripheral nervous system reactions: Headache, delerium, confusion, lethargy

  • Gastrointestinal: vomiting, nausea, anorexia, hypersalivation

  • Hematologic: changes in reticulocyte counts, anemia, altered WBC counts

  • Hypersensitivity: rash, urticaria, itching

  • Special senses: dizziness, tinnitis, vertigo

  • Renal: clinduria, oliguria, proteinuria, increased creatinine and BUN

  • Miscellaneous: apnea, alopecia, joint pain

  • Pain at injection site

  • Decreased calcium, sodium, potassium and magnesium levels  

Dosage:

  • Administered by IM or IV injection or nebulization

  • Therapy duration is generally 7-10 days

  • Dosages based on patients ideal body weight

Adults: normal renal function: 3mg/kg/day IV or IM in 3 equal doses every 8 hours

Weight
 (pounds)
Weight
 (kg)
Q8 hour Dose (Moderate Infections)
132 60 60 mg IM/IV
154 70 70 mg IM/IV
176 80 80 mg IM/IV
198 90 90 mg IM/IV

Serious infections: 5mg/kg/day divided into 3-4 equal doses
Weight 
(pounds)
Weight 
(kg)
Q8 hour Dose (Serious Infections)
132 60 100 mg IM/IV
154 70 117 mg IM/IV
176 80 133 mg IM/IV
198 90 150 mg IM/IV
  • Children:

    • 6-7.5mg/kg/day in 3-4 equally divided doses

  • Premature or full term neonates (< 1 week of age):

    • <4mg/kg/day in 2 equally divided doses

  • Cystic fibrosis nebulization:

    • Adults and Children > 6 years: 300mg twice a day

    • given on a repeating cycle: 28 days on and 28 days off

 
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