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tobramycin
generic
Black Box Warnings .
Nephrotoxicity
acute kidney injury incl. acute renal failure can occur; incr. risk w/ incr. serum trough levels, high peak levels (>12 mcg/mL), total cumulative dose, advanced age, volume depletion, concurrent or sequential nephrotoxic agents; avoid concurrent and/or sequential nephrotoxic agents; monitor serum levels and renal fxn in all pts during tx; decr. dose or D/C if renal impairment occurs
Ototoxicity
irreversible auditory and vestibular toxicity can occur and may cont. to develop after drug D/C; incr. risk w/ high serum levels, prolonged tx, renal impairment, concurrent or sequential nephrotoxic or ototoxic agents, extremes of age; avoid concurrent and/or sequential ototoxic agents; monitor auditory and vestibular toxicity s/sx; reduce dose or D/C if renal impairment occurs; D/C if ototoxicity occurs
Neuromuscular Blockade
assoc. w/ aminoglycoside use; monitor sx during tx; incr. risk w/ underlying neuromuscular disorders (incl. myasthenia gravis), concomitant neuromuscular blockers
Embryo-Fetal Toxicity
aminoglycosides can cause fetal harm when admin. to pregnant women; advise pt of potential hazard to fetus if used during pregnancy or if pt becomes pregnant during tx
Adult Dosing .
Dosage forms: INJ
infections, bacterial
- [conventional interval dosing]
- Dose: 1-1.7 mg/kg/dose IM/IV q8h; Info: use adjusted wt of IBW + 0.4 x (ABW - IBW) in obese pts; adjust dose based on serum levels
- [extended interval dosing]
- Dose: 5-7 mg/kg/dose IV q24h; Info: not indicated in pregnancy, burns, ascites, obesity, neutropenia or endocarditis; use adjusted wt of IBW + 0.4 x (ABW - IBW) in obese pts; adjust dose based on random serum levels and nomogram
pneumonia, hospital-acquired or ventilator-assoc.
- [5-7 mg/kg/dose IV q24h x7 days]
- Info: may extend duration based on clinical response; refer to IDSA guidelines; use adjusted wt of IBW + 0.4 x (ABW - IBW) in obese pts; adjust dose based on serum levels
resp. infections, cystic fibrosis pts (off-label)
- [conventional interval dosing]
- Dose: 2.5-3.5 mg/kg/dose IV q8h; Info: use adjusted wt of IBW + 0.4 x (ABW-IBW) in obese pts; adjust dose based on serum levels
- [extended interval dosing]
- Dose: 10-12 mg/kg/dose IV q24h; Info: use adjusted wt of IBW + 0.4 x (ABW-IBW) in obese pts; adjust dose based on serum levels
renal dosing
- [non-cystic fibrosis, conventional interval dosing]
- CrCl 10-50: give usual dose q12-24h; CrCl <10: give usual dose x1, then redose if serum levels <1-2 mg/mL; Info: adjust dose, frequency based on serum levels
- HD: give usual dose x1, then redose after dialysis if serum levels <1-2 mg/mL; no supplement; PD: not defined; Info: adjust dose, frequency based on serum levels
- [non-cystic fibrosis, extended interval dosing]
- CrCl 30-60: adjust frequency based on random serum levels and nomogram; CrCl <30: avoid extended interval dosing; consider conventional interval dosing
- HD: avoid extended interval dosing; consider conventional interval dosing; PD: not defined
- [cystic fibrosis, conventional interval dosing]
- CrCl 10-50: give usual dose q12-24h; CrCl <10: give usual dose x1, then redose if serum levels <1-2 mg/mL; Info: adjust dose, frequency based on serum levels
- HD: give usual dose x1, then redose after dialysis if serum levels <1-2 mg/mL; no supplement; PD: not defined; Info: adjust dose, frequency based on serum levels
- [cystic fibrosis, extended interval dosing]
- CrCl 30-60: adjust frequency based on serum levels; CrCl <30: avoid extended interval dosing; consider conventional interval dosing
- HD: avoid extended interval dosing; consider conventional interval dosing; PD: not defined
hepatic dosing
- [not defined]
Peds Dosing .
- Dosage forms: INJ
bacterial infections, neonatal dosing
- [<30 wk gestation, 0-7 days old]
- Dose: 5 mg/kg/dose IV q48h; Info: adjust dose based on serum levels
- [<30 wk gestation, 8-28 days old]
- Dose: 4 mg/kg/dose IV q36h; Info: adjust dose based on serum levels
- [<30 wk gestation, 29 days old and older]
- Dose: 4 mg/kg/dose IV q24h; Info: adjust dose based on serum levels
- [30-34 wk gestation, 0-7 days old]
- Dose: 4.5 mg/kg/dose IV q36h; Info: adjust dose based on serum levels
- [30-34 wk gestation, 8 days old and older]
- Dose: 4 mg/kg/dose IV q24h; Info: adjust dose based on serum levels
- [35 wk gestation and older, 0-28 days old]
- Dose: 4 mg/kg/dose IV q24h; Info: adjust dose based on serum levels
bacterial infections, conventional interval dosing
- [1 mo and older]
- Dose: 2.5 mg/kg/dose IV q8h; Info: adjust dose based on serum levels; consider using IBW in pts 1 mo and older
bacterial infections, extended interval dosing
- [3 mo-2 yo]
- Dose: 9.5 mg/kg/dose IV q24h; Info: adjust dose based on serum levels
- [2-8 yo]
- Dose: 8.5 mg/kg/dose IV q24h; Info: adjust dose based on serum levels
- [8 yo and older]
- Dose: 7 mg/kg/dose IV q24h; Info: adjust dose based on serum levels
resp. infections, cystic fibrosis pts
- [conventional interval dosing, 1 mo and older]
- Dose: 2.5-3.5 mg/kg/dose IV q8h; Info: adjust dose based on serum levels; consider using IBW in pts 1 mo and older
- [extended interval dosing, 1 mo and older]
- Dose: 10-12 mg/kg/dose IV q24h; Info: adjust dose based on serum levels; consider using IBW in pts 1 mo and older
febrile neutropenia, post-stem cell transplant (off-label)
- [<5 yo]
- Dose: 9 mg/kg/dose IV q24h; Info: adjust dose based on serum levels
- [5-11 yo]
- Dose: 8 mg/kg/dose IV q24h; Info: adjust dose based on serum levels
- [12 yo and older]
- Dose: 7 mg/kg/dose IV q24h; Info: adjust dose based on serum levels
UTI (off-label)
- [2 mo-2 yo]
- Dose: 5 mg/kg/day IV divided q8h x7-14 days; Info: duration varies w/ infection type, severity; adjust dose based on serum levels; consider using IBW
renal dosing
- [neonatal dosing]
- renal impairment: not defined; Info: adjust dose based on serum levels
- HD/PD: not defined; Info: adjust dose based on serum levels
- [non-cystic fibrosis, conventional interval dosing]
- CrCl 10-50: give usual dose q12-24h; CrCl <10: give usual dose q48-72h; Info: adjust dose based on serum levels
- HD: give usual dose x1, then adjust dose based on serum levels; no supplement; PD: not defined
- [non-cystic fibrosis, extended interval dosing]
- CrCl 30-60: adjust frequency based on serum levels; CrCl <30: avoid extended interval dosing; consider conventional interval dosing
- HD: avoid extended interval dosing; consider conventional interval dosing; PD: not defined
- [cystic fibrosis, conventional interval dosing]
- CrCl 10-50: give usual dose q12-24h; CrCl <10: give usual dose q48-72h; Info: adjust dose based on serum levels
- HD: give usual dose x1, then adjust dose based on serum levels; no supplement; PD: not defined
- [cystic fibrosis, extended interval dosing]
- CrCl 30-60: adjust frequency based on serum levels; CrCl <30: avoid extended interval dosing; consider conventional interval dosing
- HD: avoid extended interval dosing; consider conventional interval dosing; PD: not defined
hepatic dosing
- [not defined]