General Toxicity Notes
Nephrotoxic, ototoxic. Toxicity worse when hyperbilirubinemic. Measure serum levels for efficacy and toxicity. Peritoneal absorption increases with presence of inflammation. Vd increases with edema, obesity, and ascites. Do not use once-daily dosing in patients with CrCl <30-40 mL/min or in patients with acute renal failure or uncertain level of kidney function.
Half-Life (Normalesrd) Hours
2.5/27-60
Plasma Protein Binding %
<5
Volume Of Distribution L/Kg
0.22-0.33
Dose For Normal Renal Function
1.7 mg/kg q8h or 5-7 mg/kg qd
Adjustment For Renal Failure Method
I
Adjustment For Renal Failure Gfr, Ml/Min >50 [Recommended Level]
100% q8-24h [A]
Adjustment For Renal Failure Gfr, Ml/Min 10-50 [Recommended Level]
100% q24-48h by levels [A]
Adjustment For Renal Failure Gfr, Ml/Min <10 [Recommended Level]
100% q48-72h by levels [A]
Supplement For Dialysis [Recommendation Level]: Ihd
IHD: full dose after dialysis
Supplement For Dialysis [Recommendation Level]: Pd
PD: 3-4 mg/L/d
Supplement For Dialysis [Recommendation Level]: Crrt
CRRT: Dose for GFR 10-50, monitor levels, [B]
References
Aarons L, Vozeh S, Wenk M, Weiss P, Follath F. Population pharmacokinetics of tobramycin. Br J Clin Pharmacol. 1989; 28: 305-14. [PMID: 2789924] / Armstrong DK, Hidalgo HA, Eldadah M. Vancomycin and tobramycin clearance in an infant during continuous hemofiltration. Ann Pharmacother. 1993; 27: 224-7. [PMID: 8439703] / Brogden RN, Pinder RM, Sawyer PR, Speight TM, Avery GS. Tobramycin: a review of its antibacterial and pharmacokinetic properties and therapeutic use. Drugs. 1976; 12: 166-200. [PMID: 789045] / Bunke CM, Aronoff GR, Brier ME, Sloan RS, Luft FC. Tobramycin kinetics during continuous ambulatory peritoneal dialysis. Clin Pharmacol Ther. 1983; 34: 110-6. [PMID: 6861432] / Cigarran-Guldris S, Brier ME, Golper TA. Tobramycin clearance during simulated continuous arteriovenous hemodialysis. Contrib Nephrol. 1991; 93: 120-3. [PMID: 1802559]