Tobramycin Intravenous (patients of all ages)

Who can administer

May be administered by registered competent doctor or nurse/midwife

Dose MUST be individualised according to renal function and weight - a tobramycin dose calculator on the GAPP antimicrobial app for once-daily dosing for non-cystic fibrosis patients should be used to calculate the dose. For Cystic fibrosis (CF) patients- see below Dose
Once daily dosing is recommended for most patients
Monitoring requirements - see overleaf
Do NOT hold dose in patients less than 65 years of age, with good renal function (CrCl>80ml/min with good urine output) while waiting for levels to be reported unless there are reasonable grounds for suspecting toxicity
However, in patients over 65 years, or with abnormal renal function (CrCl <80ml/min) -it is generally preferable to await the result of the first tobramycin level (before the second dose) before giving the next dose. If the level is <1mg/L and renal function is stable, it is not necessary to routinely hold subsequent doses pending levels, unless there are obvious signs of toxicity
Prolonged duration of treatment and co-administration with nephrotoxins (eg diuretics, NSAIDs, vancomycin) increases the risk of toxicity and should be avoided where possible
Effective use of tobramycin is complex and should normally be discussed with micro/ID/CF consultants

Tobramycin 80mg per 2ml vial

Already in solution

Sodium chloride 0.9% or glucose 5%

Intermittent intravenous infusion

Once daily dose: Add required dose to 100ml infusion fluid and administer over 20 to 60 minutes
A 50ml infusion may be used if required (eg fluid restriction) but the residual volume in the infusion line must be flushed through at the same rate to avoid significant underdosing

For non-Cystic Fibrosis patients ^{(ref 1)}

Use the Tobramycin dosing calculator in the GAPP app to calculate once-daily tobramycin once-daily dose in non-CF patients
See also this table

Cystic fibrosis patients

Give 10mg/kg as a single daily dose if renal function is normal^{(ref 1)}
Maximum dose is 660mg in children less than 18 years, and 700mg for all other patients
If Actual Body Weight exceeds Ideal Body Weight by more than or equal to 30%, an Adjusted Dosing Weight should be used to calculate the dose - contact Pharmacy for advice
Renal impairment: Contact Microbiology

Monitor for ototoxicity and nephrotoxicity
Monitor tobramycin levels and urine output
Monitor renal function also as toxicity may occur in patients in whom the aminoglycoside levels have never exceeded the acceptable range
Take the first level before the second dose. Take the level within one hour before the dose is due
Blood samples must be labelled with the time sample was taken

Single daily dose	Pre-dose (trough)
	Taken just before next dose i.e. 24 hours
	Less than 1mg/L

Non-CF patients - Levels twice weekly

Cystic fibrosis patients - take level once weekly (if stable renal function)

Renal impairment/nephrotoxic risk/diuretic therapy -- take levels more frequently

Store below 25⁰C

SPC September 2021

Aminoglycoside antibiotic

BNF