Tobramycin (Intramuscular, Intravenous)

Injection route Tobramycin is an antibiotic given by a health professional. It is prescribed for serious bacterial infections, and in some cases when other antibiotics have not been successful.

Overview:

Tobramycin via injection route is sold and prescribed under the brand name Nebcin in the US. It is an aminoglycoside antibiotic which is used to treat serious bacterial infections. It is prescribed for the treatment of infections that are caused by susceptible micro-organisms. This includes infections of the central nervous system such as meningitis, septicaemia and neonatal sepsis. It may also be used to treat lower respiratory tract infections such as acute bronchitis and pneumonia as well as gastrointestinal infections. This course of treatment may also be used to treat infections of the bones, skin or soft tissues, and this includes burns. In some cases when clinical judgement or bacterial analysis proves its suitability, it may be used to treat a serious case of staphylococcal, or when other less toxic routes such as penicillin are contra-indicated.

This medicine works by killing off certain bacteria and/or inhibited further growth of dangerous bacteria. It is not used to treat colds, flus or any other viruses.

Tobramycin is normally given in hospital and can only be prescribed by a doctor, nurse or suitably qualified health professional.

This medicine can cause life-threatening allergic reactions such as anaphylaxis. It is also known to cause problems with hearing, sense of balance and also can damage the kidneys.

Tobramycin is given in an intravenous or intramuscular route as it doesn't cross the gastrointestinal tract and cannot therefore be taken orally. Alternative routes include inhalation or ophthalmic.

Conditions treated:

  • Infections of the central nervous system
  • Gastro-intestinal infections
  • Lower-respiratory tract infections
  • Bone, soft tissue and skin infections
  • Staphylococcal infections

Type of medicine:

  • Aminoglycoside antibiotics

Side Effects

In addition to the desired effect, any medicine can also cause one or more unwanted effects.

Consult your doctor, nurse or health professional immediately should any of the following side effects occur:

  1. Black/tarry stools
  2. Bleeding gums
  3. Blood in urine or stool
  4. Chills
  5. Clouded urine
  6. Clumsiness
  7. Continual ringing/buzzing /other unexplained noise in ears
  8. Coughing
  9. Cracked skin
  10. Decrease in amount of urine
  11. Dizziness or feeling or lightheadedness
  12. Feeling of constant movement of surroundings or self
  13. Feeling of fullness in ears
  14. Feverishness
  15. Loss of balance
  16. Loss of body heat
  17. Loss/change in hearing
  18. Nausea
  19. Palid skin
  20. Pinpointed red spots on skin
  21. Red and/or swollen skin
  22. Scaly skin
  23. Sensations of spinning
  24. Shortness of breath
  25. Soreness in the throat
  26. Trouble with hearing
  27. Troubled breathing and/or trouble with exertion
  28. Ulcers, sores or white spots in mouth
  29. Unsteadiness
  30. Unusual bleeding/bruising
  31. Unusual tiredness/weakness
  32. Vomiting

Immediately seek emergency assistance should the following symptom of overdose occur:

  • Inability to breathe without assistance

In addition to the above side effects, some side effects may occur which do not normally require medical attention. Such side effects may reduce or disappear during the course of the treatment as your body adjusts to it. Your healthcare provider may be able to inform you about how to prevent/reduce such side effects. Check with your healthcare provider should any of the following side effects continue, if you have any questions about them or if they are bothering you and/or hindering your day to day activities.

  1. Confusion about identity, time or place
  2. Diarrhea
  3. Headaches
  4. Hives or welts
  5. Itchy skin
  6. Pain at site of injection
  7. Red skin
  8. Skin rashes
  9. Unusual sensations of tiredness, dullness, drowsiness, weakness or a general feeling of sluggishness

Further side effects that are not listed here could also occur in some patients. Should you notice the appearance of any additional side effects, consult your healthcare professional.

Always speak to your doctor for medical advice regarding side effects. You may also want to report side effects to the FDA at 1-800-FDA-1088.

Dosage:

Tobramycin for the injection route comes as powder form which is made into a solution or more often, already in solution form (as branded Nebcin). In solution form, Tobramycin measures 40mg/ml.

A nurse, doctor or another health professional will need to give you this medicine. The medicine is given as an injection shot which needs to be injected into a vein or muscle (intravenous or intramuscular). This medicine should never be given through the eyes.

Dosage will be decided by a doctor depending on the level of infection, the patient, and also whether the patient has normal renal function, is pregnant, very young or elderly or if they have a condition such as asthma or Parkinson's.

A typical dose for a serious infection would be 3mg/kg/day, given in three doses. A life-threatening condition may require the highest dose of 5mg/kg/day, although this would be reduced as soon as possible. Dosages are normally given at eight-hour intervals.

Normal treatment time is seven to 10 days. Taking this medicine for more than 10 days has an increased likelihood of neurotoxicity.

Interactions:

Use of the following medicines is not normally recommended in conjunction with Tobramycin, however there may be instances when it is necessary for them both to be prescribed, in which case your doctor may adjust the dose of one or both.

  • Alcuronium
  • Atracurium
  • Cholera Vaccine, Live
  • Cidofovir
  • Cisatracurium
  • Colistimethate Sodium
  • Decamethonium
  • Doxacurium
  • Ethacrynic Acid
  • Fazadinium
  • Foscarnet
  • Furosemide
  • Gallamine
  • Hexafluorenium
  • Lysine
  • Mannitol
  • Metocurine
  • Mivacurium
  • Pancuronium
  • Pipecuronium
  • Rapacuronium
  • Rocuronium
  • Succinylcholine
  • Tubocurarine
  • Vancomycin
  • Vecuronium

Taking Tobramycin with any of the following medicines may increase the risk of some side effects, however taking both medicines may still be the best treatment course. When both medicines are prescribed at the same time, your doctor may adjust the doses of one or both.

  • Cisplatin
  • Cyclosporine

Medicines can also interact with food, alcohol, tobaccos and recreational drugs. It's important to inform your doctor about any intake of alcohol and tobacco before being given Tobramycin.

Warnings:

It's essential that your doctor is able to monitor and check the progress of this medicine. This allows your doctor to assess whether the medicine is working properly and to make a decision about whether you need to continue to be given it. Due to the higher risk chances of certain side effects you may require tests for blood, urine, hearing and nerves. Your blood should further be monitored for electrolytes such as calcium, magnesium, and potassium.

It's very important that if symptoms do not improve in a few days that you alert your doctor to this fact, even more so; should your symptoms get worse.

Using Tobramycin while pregnant could harm your unborn baby. Despite the risks, the medicine may still be given to pregnant patients with a life-threatening disease when the benefit outweighs the risk. Use or take an effective and reliable form of birth control in order to prevent pregnancy during the course of the medicine. If you think you've become pregnant during the course of the medicine, you should inform your doctor or health provider immediately. Like all aminoglycoside antibiotics, tobramycin is excreted in breast milk and should therefore be avoided by patients who are breastfeeding.

This medicine is sometimes known to cause serious allergic reactions as it contains sodium metabisulfite. This can include life-threatening anaphylaxis, which requires immediate medical attention. Alert your doctor straight away if you experience itching, hives, peeling, blistering or loosening of the skin, shortness of breath, hoarseness, sores, ulcers and/or white spots in the mouth or on the lips, trouble breathing, trouble swallowing or any kind of swelling on your hands, face or mouth. Asthmatic episodes and allergic reactions are more likely in asthmatic patients.

Cease use of this medicine and alert your doctor right away if you experience a sudden decrease in hearing or a partial or complete loss of hearing, this might also be accompanied by dizziness and/or a ringing in the ears. Tell your doctor if you experience dizziness or light-headedness, a feeling of constant movement of yourself or your surroundings, or perhaps a sensation of spinning. Any of these may be symptoms of damage to your hearing or to your sense of balance.

Alert your doctor or healthcare provider immediately if you notice blood in your urine, a change in the frequency of urination or an increase or decrease in the amount of urine. Alert your doctor should you have trouble with breathing, or if you experience drowsiness, an increase in thirst, a loss of appetite, a sensation of weakness, nausea, or you experience vomiting or a swelling of the lower legs or the feet. Any of these might be symptomatic of a serious kidney problem.

This medicine is known to cause nerve problems in some patients. Alert your doctor straight away should you experience a tingling of the skin, numbness, muscle twitching or seizures.

Ensure your consultant/surgeon/doctor is aware that you're taking this medicine ahead of surgery or any other procedures that require a numbing medicine, such as anaesthetics, or neuromuscular blocking agents. A tobramycin injection in combination with numbing medicines can increase your risk of difficulty in breathing, an inability to breath without assistance, drowsiness or unusual levels of weakness.

Never take any other medicines unless you have discussed this with your doctor. This is not limited to prescription medicines but also includes over-the-counter medicines, herbal remedies and vitamin supplements.

This medicine can be effective when given to children, but it should be used with extreme caution in premature or newborn babies.

The medicine can also be given to geriatric patients, however there is an increased likelihood of kidney problems which will usually mean a modified (lowered) dose.

This medicine should be used with caution in patients with Cystic Fibrosis, Parkinson's Disease, Nerve problems, Kidney Disease, a Sulfite allergy, Muscle problems, Myasthenia gravis or extensive burns.

Storage:

Tobramycin in solution form comes in rubber stopped vials. It should not be stored above 25°C.

Summary:

Tobramycin via injection route is sold and prescribed as Nebcin in the US. It is an aminoglycoside antibiotic which is prescribed and given for serious bacterial infections. The drugs works by killing bacteria and inhibited growth of certain bacteria. This includes infections of the gastrointestinal tract, the lower respiratory tract, the central nervous system and also infections of the skin, bones and soft tissue. In some cases, it may also be given to treat a serious Staphylococcal infection when less potentially toxic medicines such as penicillin are contra-indicated.

Taking Tobramycin for more than ten days can significantly increase the likelihood of neurotoxicity which can affect hearing, balance and kidney function. Tobramycin can also cause severe allergic reactions including anaphylaxis and asthmatic episodes. Patients with reduced renal function or asthma may need to have a lower dose or doctors may consider a different treatment route due to the increased risks of either allergic reaction or other side effects such as kidney failure, loss or hearing or loss of balance. This is also true of pregnant patients, elderly patients, new-born babies, patients with nerve problems, kidney problems, Parkinson's or Cystic Fibrosis. Patients who are breastfeeding may also need to cease breastfeeding as the drug can be excreted in breast milk.

Tobramycin (injection route) will be given by a health professional such as a doctor or nurse and is normally given in hospital. The drug can be given by either an intravenous or intramuscular route. Treatment should ideally be restricted to less than ten days, normally 7-10 days, with a dosage of no more than 5mg/kg/day. The highest dosage of 5mg/kg/day will be reduced as soon as possible and will only be given in the most life-threatening situations. A typical dosage for a serious bacterial infection in patients with no renal problems is 3mg/kg/day, which is given across three doses, every eight hours.

It's important that patients who are prescribed with Tobramycin (injection route) inform their doctor about all other medicines they are taking, as well as tobacco and alcohol use, as well as any underlying or pre-existing medical conditions.

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Last Reviewed:
December 24, 2017
Last Updated:
April 03, 2018
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