Tobramycin (oral inhalation)

Action and Spectrum

Tobramycin is an antibiotic that contains an aminoglycoside ring that is 4,6-disubstituted 2-deoxystreptamine (DOS) and is effective against a variety of Gram-negative and certain Gram-positive bacteria. 

Aminoglycosides are polycationic at physiological pH, they easily attach to bacterial membranes, including the phospholipids and lipopolysaccharides found in Gram-negative bacteria’s outer membrane. 

The first impact of aminoglycoside antibiotics that was identified was the inhibition of protein synthesis. According to structural and cell biology research, aminoglycosides attach to helix 44 (h44) of the 16S rRNA. 

Drug Interaction

Adverse Reaction

Frequency defined: 

>10% 

Voice disorder (10%) 

Headache (12%) 

Cough (10-30%) 

Decreased lung function (7%) 

Fever (16%)  

1%-10%: 

Skin rash (6%) 

Chest discomfort (5%) 

Weight loss (7%) 

Oral candidiasis (4%) 

Anxiety (5%) 

Musculoskeletal chest pain (5%) 

Deafness (1%) 

Throat irritation (2%) 

Balance impairment (1%) 

Dizziness (6%) 

Tinnitus (8%) 

Hypersensitivity pneumonitis (3%)  

Frequency not defined:  

Genitourinary nephrotoxicity 

Anaphylaxis 

Black Box Warning

None

Contraindication / Caution

Contraindication: 

Hypersensitivity 

Caution: 

Ototoxicity 

Nephrotoxicity 

Bronchospasm 

Development of Drug-Resistant Organisms 

Pregnancy / Lactation

Pregnancy consideration: Tobramycin (oral inhalation) can be assigned under pregnancy category N. tobramycin can be considered for the treatment of maternal infection. 

Lactation: No data available regarding the excretion of tobramycin in breast milk.  

Pregnancy category: 

• Category A: Satisfactory and well-controlled studies show no evidence of risk to the fetus in the first trimester or the later trimester. 
• Category B: There is no evidence of risk to the fetus found in animal reproduction studies and there are not enough studies on pregnant women. 
• Category C: Adverse effects on the fetus found with evidence in animal reproduction studies and no adequate evidence for an effect in humans, care must be taken for potential risks in pregnant women. 
• Category D: There is adequate data available with sufficient evidence of human fetal risk from various platforms, but despite potential risks may be used only in emergency cases for potential benefits. 
• Category X: Drugs listed in this category outweigh risks over benefits. These category drugs should be prohibited for pregnant women. 
• Category N: There is no data available for the drug under this category. 

Pharmacology

The actinomycete Streptomyces tenebrarius is the source of the aminoglycoside antibiotic tobramycin. 

Tobramycin has the potential to be nephrotoxic and ototoxic since it is absorbed and retained by the kidney’s proximal tubule and the ear’s cochlear cells. 

In vitro action against a variety of gram-negative bacteria, including Pseudomonas aeruginosa. 

Adminstartion

It is used as only in oral inhalation from. 

For Bethkis: 

Use an APRI Vios Air compressor and a handheld PARI LC Plus reusable nebulizer to administer over a period of fifteen minutes. 

For TOBI: 

Use a DeVilbiss Pulmo-Aide compressor and a handheld PARI LC Plus reusable nebulizer to administer over a period of fifteen minutes. 

Doses should be administered as close to 12 hours apart as possible and never less than 6 hours apart. 

It is advised that patients undergoing chest physical therapy or taking multiple inhaled drugs take the TOBI Podhaler last. 

Patient Information Leaflet

Patient information leaflet 

Generic Name: tobramycin (oral inhalation) 

Why do we use tobramycin (oral inhalation)?  

Tobramycin (oral inhalation) is used for the management of cystic fibrosis. 

It is also indicated for management of pseudomonas aeruginosa patients.