• Tobramycin indications
• Uses of Tobramycin in details
• Tobramycin description
• Tobramycin dosage
• Tobramycin interactions
• Tobramycin side effects
• Tobramycin contraindications

What is Tobramycin?

Tobramycin is an aminoglycoside (ah-meen-oh-GLY-ko-side) antibiotic. Tobramycin fights infections that are caused by bacteria.

Tobramycin inhalation is inhaled into the lungs using a nebulizer. Tobramycin inhalation is used to treat lung infections in patients with cystic fibrosis.

Tobramycin inhalation is for use in adults and children who are at least 6 years old.

Tobramycin inhalation may also be used for purposes not listed in this medication guide.

Tobramycin indications

To reduce the development of drug-resistant bacteria and maintain the effectiveness of Tobramycin injection and other antibacterial drugs, Tobramycin injection should be used only to treat or prevent infections that are proven or strongly suspected to be caused by susceptible bacteria. When culture and susceptibility information are available, they should be considered in selecting or modifying antibacterial therapy. In the absence of such data, local epidemiology and susceptibility patterns may contribute to the empiric selection of therapy.

Tobramycin injection is indicated for the treatment of serious bacterial infections caused by susceptible strains of the designated microorganisms in the diseases listed below:

Septicemia in the pediatric patient and adult caused by P. aeruginosa, E. coli, and Klebsiella sp.

Lower respiratory tract infections caused by P. aeruginosa, Klebsiella sp, Enterobacter sp, Serratia sp, E. coli, and S. aureus (penicillinase and non-penicillinase-producing strains).

Serious central nervous system infections (meningitis) caused by susceptible organisms.

Intra-abdominal infections, including peritonitis, caused by E. coli, Klebsiella sp, and Enterobacter sp.

Skin, bone and skin-structure infections caused by P. aeruginosa, Proteus sp, E. coli, Klebsiella sp, Enterobacter sp, and S. aureus.

Complicated and recurrent urinary tract infections caused by P. aeruginosa, Proteus sp (indole-positive and indole-negative), E. coli, Klebsiella sp, Enterobacter sp, Serratia sp, S. aureus, Providencia sp, and Citrobacter sp.

Aminoglycosides, including Tobramycin, are not indicated in uncomplicated initial episodes of urinary tract infections unless the causative organisms are not susceptible to antibiotics having less potential toxicity. Tobramycin may be considered in serious staphylococcal infections when penicillin or other potentially less toxic drugs are contraindicated and when bacterial susceptibility testing and clinical judgment indicate its use.

Bacterial cultures should be obtained prior to and during treatment to isolate and identify etiologic organisms and to test their susceptibility to Tobramycin. If susceptibility tests show that the causative organisms are resistant to Tobramycin, other appropriate therapy should be instituted. In patients in whom a serious life-threatening gram-negative infection is suspected, including those in whom concurrent therapy with a penicillin or cephalosporin and an aminoglycoside may be indicated, treatment with Tobramycin may be initiated before the results of susceptibility studies are obtained. The decision to continue therapy with Tobramycin should be based on the results of susceptibility studies, the severity of the infection, and the important additional concepts discussed in the WARNINGS box above.

How should I use Tobramycin?

Use Tobramycin ointment as directed by your doctor. Check the label on the medicine for exact dosing instructions.

• Remove contact lenses before you use Tobramycin ointment.
• Do not wear contact lenses while you are using Tobramycin ointment. Take care of your contact lenses as directed by the manufacturer. Check with your doctor before you use them.
• Tobramycin ointment may be used around the eye or in the eye. To use Tobramycin ointment in the eye, first, wash your hands. Using your index finger, pull the lower eyelid away from your eye to form a pouch. Squeeze a thin strip of ointment into the pouch. After using Tobramycin ointment, gently close your eyes for 1 to 2 minutes. Wash your hands to remove any medicine that may be on them. Wipe the applicator tip with a clean, dry tissue.
• To prevent germs from contaminating your medicine, do not touch the applicator tip to any surface, including the eye. Keep the container tightly closed.
• To clear up your infection completely, take/use Tobramycin ointment for the full course of treatment. Keep taking/using it even if you feel better in a few days.
• Tobramycin ointment works best if it is used at the same time each day.
• Do not miss any doses. If you miss a dose of Tobramycin ointment, use it as soon as possible. If it is almost time for your next dose, skip the missed dose and go back to your regular dosing schedule.

Ask your health care provider any questions you may have about how to use Tobramycin ointment.

Uses of Tobramycin in details

Use: Labeled Indications

Cystic fibrosis: Management of cystic fibrosis in adults and pediatric patients ≥6 years of age with Pseudomonas aeruginosa.

Limitations of use: Safety and efficacy have not been demonstrated in patients with FEV <25% or >75% predicted (Tobramycin; Tobramycin), or in patients colonized with Burkholderia cepacia.

Off Label Uses

Non-cystic fibrosis bronchiectasis

According to a national consensus summary and international guidelines, aerosolized Tobramycin should not be used for the treatment and prevention of non-cystic fibrosis bronchiectasis. Aerosolized antibiotics may be considered in patients who have experienced 3 or more exacerbations requiring antibiotic therapy per year; organism sensitivity should be considered when choosing an antibiotic. The risk of adverse events, cost of therapy, and patient status should be considered prior to initiating aerosolized Tobramycin because the efficacy of aerosolized Tobramycin in the treatment of non-cystic fibrosis bronchiectasis has not been well documented.

Tobramycin description

An aminoglycoside, broad-spectrum antibiotic produced by Streptomyces tenebrarius. It is effective against gram-negative bacteria, especially the pseudomonas species. It is a 10% component of the antibiotic complex, nebramycin, produced by the same species. [PubChem]

Tobramycin dosage

Tobramycin Dosage

Generic name: Tobramycin 300mg in 5mL

Dosage form: inhalation solution

The information at Drugs.com is not a substitute for medical advice. Always consult your doctor or pharmacist.

Dosing Information

• Tobramycin is a co-packaging of Tobramycin inhalation solution ampules with a PARI LC PLUS Reusable Nebulizer. Administer as follows: One single-use ampule (300 mg /5 mL) of Tobramycin inhalation solution twice a day by oral inhalation in alternating periods of 28 days on drug, followed by 28 days off drug.
• The 300 mg/5mL dose of Tobramycin inhalation solution is the same for all patients regardless of age or weight.
• The doses should be taken as close to 12 hours apart as possible; they should not be taken less than 6 hours apart.

Administration of Tobramycin Inhalation Solution

Each dose of Tobramycin inhalation solution is administered by oral inhalation using only the co-packaged PARI LC PLUS Reusable Nebulizer (Model No. 022B81-T) included in the Tobramycin, along with a DeVilbiss Pulmo-Aide air compressor (Model No. 5650D).

Tobramycin inhalation solution is not for subcutaneous, intravenous or intrathecal administration.

Prior to administration, read the Patient Information/Instructions for Use for Tobramycin for detailed information on how to use Tobramycin and follow the manufacturer's instructions for use and care of the DeVilbiss Pulmo-Aide air compressor.

The entire Tobramycin inhalation solution treatment should take approximately 15 minutes to complete. Continue treatment until all the Tobramycin inhalation solution has been delivered, and there is no longer any mist being produced.

Tobramycin inhalation solution should not be diluted or mixed with other drugs including dornase alfa (Pulmozyme®) in the nebulizer. Instruct patients on multiple therapies to take their medications prior to inhaling the Tobramycin inhalation solution, or as directed by their physician.

Tobramycin inhalation solution should not be used if it is cloudy, if there are particles in the solution, or if it has been stored at room temperature for more than 28 days.

More about Tobramycin (Tobramycin)

• Side Effects
• During Pregnancy or Breastfeeding
• Dosage Information
• Drug Interactions
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• Pricing & Coupons
• 0 Reviews - Add your own review/rating
• Generic Availability

Consumer resources

• Tobramycin (Advanced Reading)

• Other brands: Tobramycin, Bethkis, Tobramycin, Nebcin

Professional resources

• Tobramycin (FDA)
• Tobramycin (AHFS Monograph)

Related treatment guides

• Cystic Fibrosis

Tobramycin interactions

See also:
What other drugs will affect Tobramycin?

No clinical drug interaction studies have been performed with Tobramycin. In clinical studies, patients receiving Tobramycin continued to take dornase alfa, bronchodilators, inhaled corticosteroids, and macrolides. No clinical signs of drug interactions with these medicines were identified.

Concurrent and/or sequential use of Tobramycin with other drugs with neurotoxic, nephrotoxic, or ototoxic potential should be avoided.

Some diuretics can enhance aminoglycoside toxicity by altering antibiotic concentrations in serum and tissue. Tobramycin should not be administered concomitantly with ethacrynic acid, furosemide, urea, or intravenous mannitol. The interaction between inhaled mannitol and Tobramycin has not been evaluated.

Tobramycin side effects

See also:
What are the possible side effects of Tobramycin?

Clinical Trials Experience

Because clinical trials are conducted under widely varying conditions, adverse reaction rates observed in the clinical trials of a drug cannot be directly compared to rates in the clinical trials of another drug and may not reflect the rates observed in practice.

Tobramycin has been evaluated for safety in 425 cystic fibrosis patients exposed to at least one dose of Tobramycin, including 273 patients who were exposed across three cycles (6 months) of treatment. Each cycle consisted of 28 days on-treatment (with 112 mg administered twice-daily) and 28 days off-treatment. Patients with serum creatinine ≥2 mg/dL and blood urea nitrogen (BUN) ≥40 mg/dL were excluded from clinical studies. There were 218 males and 207 females in this population, and reflecting the cystic fibrosis population in the U.S., the vast majority of patients were Caucasian. There were 221 patients ≥20 years old, 121 patients ≥13 to <20 years old, and 83 patients ≥6 to <13 years old. There were 239 patients with screening FEV1 % predicted ≥50%, 156 patients with screening FEV1 % predicted <50%, and 30 patients with missing FEV1 % predicted.

The primary safety population reflects patients from Study 1, an open-label study comparing Tobramycin with Tobramycin (Tobramycin inhalation solution, USP) over three cycles of 4 weeks on treatment followed by 4 weeks off treatment. Randomization, in a planned 3:2 ratio, resulted in 308 patients treated with Tobramycin and 209 patients treated with Tobramycin. For both the Tobramycin and Tobramycin groups, mean exposure to medication for each cycle was 28 to 29 days. The mean age for both arms was between 25 and 26 years old. The mean baseline FEV1 % predicted for both arms was 53%.

Table 1 displays adverse drug reactions reported by at least 2% of Tobramycin patients in Study 1, inclusive of all cycles (on and off treatment). Adverse drug reactions are listed according to MedDRA system organ class and sorted within system organ class group in descending order of frequency.

Table 1: Adverse Reactions Reported in Study 1 (Occurring in ≥2% of Tobramycin Patients)

1This includes adverse events of pulmonary or cystic fibrosis exacerbations
Primary System Organ Class Preferred Term	Tobramycin N=308 %	Tobramycin N=209 %
Respiratory, thoracic, and mediastinal disorders
Cough	48.4	31.1
Lung disorder1	33.8	30.1
Productive cough	18.2	19.6
Dyspnea	15.6	12.4
Oropharyngeal pain	14.0	10.5
Dysphonia	13.6	3.8
Hemoptysis	13.0	12.4
Nasal congestion	8.1	7.2
Rales	7.1	6.2
Wheezing	6.8	6.2
Chest discomfort	6.5	2.9
Throat irritation	4.5	1.9
Gastrointestinal disorders
Nausea	7.5	9.6
Vomiting	6.2	5.7
Diarrhea	4.2	1.9
Dysgeusia	3.9	0.5
Infections and infestations
Upper respiratory tract infection	6.8	8.6
Investigations
Pulmonary function test decreased	6.8	8.1
Forced expiratory volume decreased	3.9	1.0
Blood glucose increased	2.9	0.5
Vascular disorders
Epistaxis	2.6	1.9
Nervous system disorders
Headache	11.4	12.0
General disorders and administration site conditions
Pyrexia	15.6	12.4
Musculoskeletal and connective tissue disorders
Musculoskeletal chest pain	4.5	4.8
Skin and subcutaneous tissue disorders
Rash	2.3	2.4

Adverse drug reactions that occurred in <2% of patients treated with Tobramycin in Study 1 were: bronchospasm (Tobramycin 1.6%, Tobramycin 0.5%); deafness including deafness unilateral (reported as mild to moderate hearing loss or increased hearing loss) (Tobramycin 1.0%, Tobramycin 0.5%); and tinnitus (Tobramycin 1.9%, Tobramycin 2.4%).

Discontinuations in Study 1 were higher in the Tobramycin arm compared to Tobramycin (27% Tobramycin versus 18% Tobramycin). This was driven primarily by discontinuations due to adverse events (14% Tobramycin versus 8% Tobramycin). Higher rates of discontinuation were seen in subjects ≥20 years old and those with baseline FEV1 % predicted <50%.

Respiratory related hospitalizations occurred in 24% of the patients in the Tobramycin arm and 22% of the patients in the Tobramycin arm. There was an increased new usage of antipseudomonal medication in the Tobramycin arm (65% Tobramycin versus 55% Tobramycin). This included oral antibiotics in 55% of Tobramycin patients and 40% of Tobramycin patients and intravenous antibiotics in 35% of Tobramycin patients and 33% of Tobramycin patients. Median time to first antipseudomonal usage was 89 days in the Tobramycin arm and 112 days in the Tobramycin arm.

The supportive safety population reflects patients from two studies: Study 2, a double-blind, placebo-controlled design for the first treatment cycle, followed by all patients receiving Tobramycin (replaced placebo) for two additional cycles, and Study 3, a double-blind, placebo-controlled trial for one treatment cycle only. Placebo in these studies was inhaled powder without the active ingredient, Tobramycin. The patient population for these studies was much younger than in Study 1 (mean age 13 years old).

Adverse drug reactions reported more frequently by Tobramycin patients in the placebo-controlled cycle (Cycle 1) of Study 2, which included 46 Tobramycin and 49 placebo patients, were:

Respiratory, thoracic, and mediastinal disorders

Pharyngolaryngeal pain (Tobramycin 10.9%, placebo 0%); dysphonia (Tobramycin 4.3%, placebo 0%)

Gastrointestinal disorders

Dysgeusia (Tobramycin 6.5%, placebo 2.0%)

Adverse drug reactions reported more frequently by Tobramycin patients in Study 3, which included 30 Tobramycin and 32 placebo patients, were:

Respiratory, thoracic, and mediastinal disorders

Cough (Tobramycin 10%, placebo 0%)

Ear and labyrinth disorders

Hypoacusis (Tobramycin 10%, placebo 6.3%)

Audiometric Assessment

In Study 1, audiology testing was performed in a subset of approximately 25% of Tobramycin (n=78) and Tobramycin (n=45) patients. Using the criteria for either ear of ≥10 dB loss at two consecutive frequencies, ≥20 dB loss at any frequency, or loss of response at three consecutive frequencies where responses were previously obtained, five Tobramycin patients and three Tobramycin patients were judged to have ototoxicity, a ratio similar to the planned 3:2 randomization for this study.

Audiology testing was also performed in a subset of patients in both Study 2 (n=13 from the Tobramycin group and n=9 from the placebo group) and Study 3 (n=14 from the Tobramycin group and n=11 from the placebo group). In Study 2, no patients reported hearing complaints but two Tobramycin patients met the criteria for ototoxicity. In Study 3, three Tobramycin and two placebo patients had reports of ‘hypoacusis.’ One Tobramycin and two placebo patients met the criteria for ototoxicity. In some patients, ototoxicity was transient or may have been related to a conductive defect.

Cough

Cough is a common symptom in cystic fibrosis, reported in 42% of the patients in Study 1 at baseline. Cough was the most frequently reported adverse event in Study 1 and was more common in the Tobramycin arm (48% Tobramycin versus 31 % Tobramycin). There was a higher rate of cough adverse event reporting during the first week of active treatment with Tobramycin (i.e., the first week of Cycle 1). The time to first cough event in the Tobramycin and Tobramycin groups were similar thereafter. In some patients, cough resulted in discontinuation of Tobramycin treatment. Sixteen patients (5%) receiving treatment with Tobramycin discontinued study treatment due to cough events compared with 2 (1%) in the Tobramycin treatment group. Children and adolescents coughed more than adults when treated with Tobramycin, yet the adults were more likely to discontinue: of the 16 patients on Tobramycin in Study 1 who discontinued treatment due to cough events, 14 were ≥20 years of age, one patient was between the ages of 13 and <20, and one was between the ages of 6 and <13. The rates of bronchospasm (as measured by ≥20% decrease in FEV1 % predicted post-dose) were approximately 5% in both treatment groups, and none of these patients experienced concomitant cough.

In Study 2, cough was the most commonly reported adverse event during the first cycle of treatment (the double blind period of treatment) and occurred more frequently in placebo-treated patients (26.5%) than patients treated with Tobramycin (13%). Similar percentages of patients in both treatment groups reported cough as a baseline symptom. In Study 3, cough events were reported by three patients in the Tobramycin group (10%) and none in the placebo group (0%).

Postmarketing Experience

The following adverse reactions have been identified during postapproval use of Tobramycin. Because these reactions are reported voluntarily from a population of uncertain size, it is not always possible to reliably estimate their frequency or establish a causal relationship to drug exposure.

Respiratory, thoracic, and mediastinal disorders

Aphonia, Sputum discolored

General disorders and administration site conditions

Malaise

Tobramycin contraindications

See also:
What is the most important information I should know about Tobramycin?

A hypersensitivity to any aminoglycoside is a contraindication to the use of Tobramycin. A history of hypersensitivity or serious toxic reactions to aminoglycosides may also contraindicate the use of any other aminoglycoside because of the known cross-sensitivity of patients to drugs in this class.

Active ingredient matches for Tobramycin:

Tobramycin

Unit description / dosage (Manufacturer)	Price, USD
Solution; Ophthalmic; Tobramycin 0.3%
Injectable; Injection; Tobramycin Sulfate 40 mg / ml
Solution; Inhalation; Tobramycin 60 mg / ml
Injectable; Injection; Tobramycin Sulfate 10 mg / ml
Injectable; Injection; Tobramycin 40 mg / ml
Injectable; Injection; Tobramycin Sulfate 1.2 g
Tobi / 1 Box = 56, 5ml Ampules = 280ml Total 280ml Plastic Container	$ 4461.42
Tobramycin 1.2 gm vial	$ 338.25
TobraDex 0.3-0.1% Suspension 10ml Bottle	$ 200.43
TobraDex 0.3-0.1% Ointment 3.5 gm Tube	$ 126.67
TobraDex 0.3-0.1% Suspension 5ml Bottle	$ 98.11
Tobrex 0.3% Ointment 3.5 gm Tube	$ 80.02
Tobrex 0.3% Solution 5ml Bottle	$ 67.58
TobraDex 0.3-0.1% Suspension 2.5ml Bottle	$ 54.99
Tobramycin sulfate powder	$ 53.55
Tobradex eye drops	$ 19.27
Tobi 300 mg/5 ml solution	$ 17.58
Tobramycin Sulfate 0.3% Solution 5ml Bottle	$ 15.99
Tobrex 0.3% eye drops	$ 13.00
Tobi 60 mg/ml Solution	$ 11.40
Tobramycin Sulfate 40 mg/ml Solution	$ 3.60
Tobramycin 40 mg/ml	$ 3.14
Tobramycin 0.3% eye drops	$ 2.99
Aktob 0.3% eye drops	$ 2.85
Tobrex 0.3 % Ointment	$ 2.66
Tobramycin 10 mg/ml	$ 2.26
Tobrex 0.3 % Solution	$ 1.88
Pms-Tobramycin 0.3 % Solution	$ 1.05
Sandoz Tobramycin 0.3 % Solution	$ 1.05
Tobramycin 60 mg/50 ml ns	$ 0.19
Tobramycin 60 mg Injection	$ 0.48
Tobramycin solution 300 mg/5mL (Sandoz Inc (US))
Tobramycin injection, solution 40 mg/mL (Hospira, Inc. (US))
Tobramycin solution/ drops 3 mg/mL (REMEDYREPACK INC. (US))
Tobramycin solution 3 mg/mL (Lake Erie Medical DBA Quality Care Products LLC (US))
Tobramycin injection 40 mg/mL (Mylan Institutional LLC (US))
Tobramycin injection, solution 10 mg/mL (Fresenius Kabi USA, LLC (US))
Tobramycin injection 1200 mg/30mL (Xellia Pharmaceuticals Ap S (US))
List of Tobramycin substitutes (brand and generic names):
Tobramycetin
Tobramycin 80mg/2mL Faulding (Kuwait)
Tobramycin Abbott (Kuwait)
Tobramycin Actavis (Bulgaria)
Tobramycin Actavis 80 mg/2 mL x 5 Bottle x 2 mL
Tobramycin Alcon (Thailand)
Tobramycin Alcon 0.3 % x 5 mL
Tobramycin AN (Australia)
Tobramycin B. Braun (Germany)
Tobramycin B. Braun 1 mg/ml (Austria, Germany)
Tobramycin B. Braun 3 mg/ml (Austria, Germany)
Tobramycin Bausch & Lomb (United States)
Tobramycin BP (New Zealand)
Tobramycin Cid (Egypt)
Tobramycin Drops
TOBRAMYCIN EYE DROP
TOBRAMYCIN EYE DROP 1 packet / 10 ML eye drop each (Jan Aushadhi)	$ 0.14
Tobramycin Fera (United States)
Tobramycin Fresenius Kabi (Canada)
Tobramycin Hospira (Malta)
Tobramycin Ifet (Greece)
Tobramycin in Sodium Chloride Injection
tobramycin inhalation
Tobramycin Injection (Australia, New Zealand)
Tobramycin Injection solution 40 mg (Fresenius Kabi Canada Ltd (Canada))
Tobramycin Injection solution 10 mg (Fresenius Kabi Canada Ltd (Canada))
Tobramycin Mylan (Australia)
Tobramycin Novex (United States)
Tobramycin Ointment
Tobramycin Ophth (Taiwan)
Tobramycin Ophth Soln (Taiwan)
Tobramycin Ophth Soln / Wu Fu 3 mg/1 mL x 5 mL
Tobramycin PF (Australia)
Injectable; Injection; Tobramycin Sulfate 40 mg / ml
Tobramycin Pfizer (Australia)
Tobramycin powder
Tobramycin Premix Choongwae (South Korea)
Tobramycin Sandoz (Canada)
Tobramycin Solution
5 milliliter in 1 bottle, dropper
Tobramycin Stada Pymepharco (Vietnam)
Tobramycin Stada Pymepharco 80 mg/2 mL x 10 Bottle x 2mL
Tobramycin SteriMax (Canada)
Tobramycin Sulfate (Canada, United States)
Tobramycin Sulfate injection 40 mg/mL (Pfizer Laboratories Div Pfizer Inc (US))
Tobramycin Sulfate ADD-Vantage
Tobramycin Sulfate Akorn-Strides (United States)
Tobramycin Sulfate Apothecon (United States)
Tobramycin Sulfate APP (United States)
Tobramycin Sulfate Baxter (United States)
See 947 substitutes for Tobramycin

References

1. DailyMed. "TOBRAMYCIN SULFATE: DailyMed provides trustworthy information about marketed drugs in the United States. DailyMed is the official provider of FDA label information (package inserts).". https://dailymed.nlm.nih.gov/dailyme... (accessed September 17, 2018).
2. PubChem. "tobramycin". https://pubchem.ncbi.nlm.nih.gov/com... (accessed September 17, 2018).
3. DrugBank. "tobramycin". http://www.drugbank.ca/drugs/DB00684 (accessed September 17, 2018).

Reviews

The results of a survey conducted on ndrugs.com for Tobramycin are given in detail below. The results of the survey conducted are based on the impressions and views of the website users and consumers taking Tobramycin. We implore you to kindly base your medical condition or therapeutic choices on the result or test conducted by a physician or licensed medical practitioners.

User reports

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Information checked by Dr. Sachin Kumar, MD Pharmacology