Low
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Monitor creatinine at least weekly and more often if levels are elevated or other signs of renal dysfunction arise. Discontinue if any signs of ototoxicity (tinnitus, fullness in ears, dizziness).
Serum Level Monitoring for EXTENDED Interval Dosing, pediatrics: For most patients and indications, no levels are necessary, unless: Patients suspected at high risk for development of nephrotoxicity or renal dysfunction, or duration of treatment more than 5 days. In these cases check 10-12 hour level and plot on hartford nomogram.
Serum Level Monitoring for EXTENDED Interval Dosing, neonates: If plan is to discontinue tobramycin pending 48-hour culture results, no levels are required unless indicated for renal dysfunction. If plan is to continue antibiotics beyond 5 days, Goal level less than 1 mcg/mL.
Nephrotoxicity (non-oliguric) - less common with once daily dosing; greater toxicity with longer duration and supratherapeutic trough levels; avoid concomitant nephrotoxins
Vestibulocochlear toxicity (irreversible) - suggest audiology testing if prolonged use
Can exacerbate neuromuscular blockade - e.g. contraindicated in patients with myasthenia gravis.
Enhanced nephrotoxic effect with concomitant use of other nephrotoxins
Enhanced ototoxicity with loop diuretics (e.g. furosemide)
Non-depolarizing muscle relaxants may be potentiated
Antimicrobial class: Aminoglycoside
Average serum half life: Neonates: ≤1200 g: 11 hours, >1,200 g: 2 to 9 hours.
Infants: 4 ± 1 hour.
Children: 2 ± 1 hour.
Adolescents: 1.5 ± 1 hour
Adults: IV: 1-2 hours; directly dependent upon glomerular filtration rate
Adults with impaired renal function: 5- 70 hours
Route of Elimination: With normal renal function, 93% of dose excreted in urine within 24 hours
