Tobramycin

Hypersensitivity to tobramycin and other aminoglycosides.

Patient with hearing impairment, hypocalcaemia, neuromuscular disorder (e.g. myasthenia gravis, Parkinson's disease), dehydration; severe and active haemoptysis (inhalation); family history of ototoxicity. Patient with known m.1555A>G mitochondrial mutations. Renal impairment. Children. Pregnancy and lactation. Patient Counselling Ophthalmic: This drug may cause temporary blurred vision, if affected, do not drive or operate machinery. Wearing of contact lens is not recommended during treatment. Monitoring Parameters Monitor serum Ca, Mg and Na; BUN, serum creatinine, urinalysis, urine output, peak and trough plasma tobramycin levels. Assess hearing level prior to, during, and following treatment. Perform culture and sensitivity tests; consult local recommendations before treatment initiation due to antibiotic resistance risks.

Significant: Nephrotoxicity, ototoxicity (e.g. tinnitus, hearing loss, vertigo), neurotoxicity, bronchospasm (inhalation), neuromuscular blockade, respiratory failure, prolonged respiratory paralysis. Cardiac disorders: Dyspnoea. Eye disorders: Lid itching, swelling and conjunctival erythema (ophthalmic). Gastrointestinal disorders: Nausea, oropharyngeal pain, vomiting, diarrhoea, dysgeusia. General disorders and administration site conditions: Malaise, pyrexia. Investigations: Decreased pulmonary function test. Musculoskeletal and connective tissue disorders: Myalgia. Nervous system disorders: Dizziness, headache. Respiratory, thoracic and mediastinal disorders: Laryngitis (inhalation), rhinitis, dysphonia, discoloured sputum, respiratory disorder, cough, wheezing, rales, nasal congestion, epistaxis. Skin and subcutaneous tissue disorders: Pruritus, urticaria, rash. Vascular disorders: Haemoptysis (inhalation).
Potentially Fatal: Superinfection, including C. difficile-associated diarrhoea and pseudomembranous colitis (prolonged use). Rarely, anaphylaxis, dermatologic reactions (e.g. exfoliative dermatitis, toxic epidermal necrolysis, erythema multiforme, Stevens-Johnson syndrome).

Enhanced of neurotoxic or nephrotoxic effects with other aminoglycosides (e.g. amikacin, streptomycin, gentamicin), amphotericin B, viomycin, polymyxin B, cisplatin, vancomycin. May increase risk of nephrotoxicity with other antibacterials (e.g. cephalosporins), ciclosporin, mannitol. Enhanced blockade of respiratory paralysis with skeletal muscle relaxants. May increase risk of nephrotoxicity and ototoxicity with platinum compounds, potent diuretics (e.g. ethacrynic acid, furosemide). Antagonistic effect with neostigmine and pyridostigmine. May potentiate the effects of warfarin and phenindione.

Aminoglycosides / Eye Anti-Infectives & Antiseptics

S01AA12 - tobramycin ; Belongs to the class of antibiotics. Used in the treatment of eye infections.
J01GB01 - tobramycin ; Belongs to the class of other aminoglycosides. Used in the systemic treatment of infections.