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 patient’s 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

• 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