Tobramycin

Tobramycin is a doctor prescribed inhaled medication used to treat infections in the lungs in those patients who suffer from the disease cystic fibrosis with the presence of the bacteria named pseudomonas aeruginosa which the drug has been demonstrated to effectively kill.

Overview

What is Tobramycin inhalation?

Tobramycin is classed as an aminoglycoside antibiotic drug, which means that it works by killing bacteria or preventing them from growing by binding to the bacteria and preventing them from thriving, causing them to die and thereby curing the infection. Tobramycin may also be known under the brand names Bethkis, Kitabis Pak, Tobi and Tobi Podhaler.

Tobramycin is specifically formulated to work against bacterial infections, particularly gram-negative infections and it is very effective against species of pseudomonas. Pseudomonae strains are resistant against penicillin and a majority of antibiotics, making them especially difficult to kill. Tobramycin specifically targets these bacteria.

Cystic fibrosis patients typically suffer from frequent lung infections, which may be caused by a strain of pseudomona bacteria. For this reason, Tobramycin is often prescribed for cystic fibrosis patients.

How does Tobramycin work?

Tobramycin works by directly fighting the bacteria found in some lung infections. Inhaled by nebulizer directly into the lungs as a prescribed medical treatment, the active ingredients in Tobramycin attack the protein synthesis action of the bacterial cells, rendering the membrane of the cell permeable and eventually causing the death of the bacterial cell.

Typical of drugs that must be administered by inhalation, Tobramycin cannot be taken in tablet form as it would not survive the gastro-intestinal tract. Thus a nebulizer is used to administer Tobramycin to the infected patient. A nebulizer is designed to administer medication in the form of an inhaled mist with the use of compressed air to propel the drug.

What is cystic fibrosis?

Cystic fibrosis is a genetic disorder that affects the lungs and may also cause damage to the liver, pancreas, kidneys and intestine. Cystic fibrosis has no known cure and it is estimated that one in 25 people carry the faulty gene that causes the condition. Only a physician can perform the tests necessary to make a clinical diagnosis. People with cystic fibrosis experience a build-up of thick, sticky mucus in the lungs, which often leads to lung infections.

Long term issues include breathing difficulty and coughing up mucus due to frequent lung infections. Cystic fibrosis sufferers may also have chronic sinus infections, exhibit poor growth during their younger years and infertility in some males along with other physical symptoms. Different patients exhibit different symptoms, but typical cystic fibrosis sufferers exhibit the following symptoms:

  • Accumulation of thick, sticky mucus
  • Frequent chest infection
  • Coughing
  • Shortness of breath
  • Frequent sinus infection
  • Fatty stool

Cystic fibrosis often has the following physical results:

  • Infertility in males
  • Salty-tasting skin
  • Poor growth
  • Poor weight gain
  • Clubbed fingers or toes

Conditions treated

  • Respiratory infection due to cystic fibrosis, bacterial sinusitis

Type of medicine

  • Aminoglycoside antibiotic

Side effects

Some medications, in the course of their desired effects, also cause unwanted side effects during the course of treatment. These side effects are often mild and of short duration, and will typically stop completely once the course of treatment is over. Tobramycin inhalation medication may cause the following side effects during treatment:

  • Bloody nose
  • Difficulty breathing
  • Discolored mucus
  • Fever
  • Runny nose
  • Sneezing
  • Congestion
  • Raspy or hoarse voice
  • Black stool
  • Pain in the chest area
  • Chills
  • Ringing or buzzing or other unexplained noise in the ears
  • Hearing loss
  • Urination difficulty or pain during
  • Soreness in throat
  • Ulcers, sores, or spots on lips or in mouth
  • Glandular swelling
  • Chest tightness
  • Bleeding or bruising in unusual areas
  • Fatigue or weakness

If these side effects occur and you consider them to be severe or prolonged, contact your health care provider immediately.

This medication may cause damage to hearing, equilibrium as well as to kidney function. If you are experiencing the following side effects, report them to your doctor immediately as they may be the signs of underling long-term health issues that could be irreversible:

  • Hearing loss
  • Ringing or buzzing in the ears
  • Headaches
  • Nausea
  • Vomiting
  • Dizziness
  • Blood in urine
  • Change to frequency of urination
  • Difficulty breathing
  • Increased thirst
  • Swollen feet
  • Swollen legs
  • Weakness

Regular visits to your doctor, complete with blood and urine tests as well as hearing checks, will be necessary while you are on a course of Tobramycin to be certain that you aren’t experiencing any unwanted side effects.

The following side effects are directly the result of an overdose of Tobramycin and should be reported to your doctor right away:

  • Blue lips, fingernails, or skin
  • Dizziness or lightheadedness
  • Drowsiness
  • Feeling of constant movement of self or surroundings
  • Irregular or shallow breathing
  • Spinning sensation

Dosage

Tobramycin will be prescribed by your health care professional and you will be clearly instructed on its use including the amount, frequency and duration of the treatment. Use of more than the prescribed dose of this medication or use of the prescribed dose more often or for a longer duration than your doctor has instructed is not advised, as this could cause an unsafe overdose of the medication and will not increase the effectiveness.

Tobramycin needs time to build up and fight the bacteria causing the infection, so continue with the treatment as prescribed until the end, even if improvements to symptoms aren’t immediately apparent. If you stop using the medication sooner than prescribed, the infection not entirely clear up and you could suffer a relapse.

Tobramycin is prescribed in the form of an ampule, which can be described as a small plastic container. Every ampule equals one Tobramycin dose which is formulated for use with a nebulizer that mists the drug into the lungs when you inhale. It will take 10 or 15 minutes to use all the medicine that the ampule empties into the nebulizer cup. After each use, clean the nebulizer to avoid any bacterial growth that could prove harmful to your health.

Alternatively, Tobramycin is provided as a capsule contained in a blister pack that is also formulated to be used with a nebulizer. As with the ampule solution form of Tobramycin, it is recommended that a new nebulizer device is used every 7 days.

Swallowing the Tobramycin capsules or ampules is not the intended use; they are only effectively used with the nebulizer device that you received with your prescription. To use the nebulizer, exhale a full breath to remove as much air out of your lungs as you can. Place the mouth piece of the nebulizer upright into your mouth as shown on the information provided. Inhale in a slow and deep manner, holding your breath for five seconds or so then exhale slowly. Repeat the inhaled dosage until the capsule is empty, checking the capsule after inhaling.

The amount of Tobramycin you are prescribed is determined by your age, health status and symptoms you are experiencing and is specifically designed to treat your condition by your health care professional. The following dosage information represents the average prescribed amounts for each condition and age group. Your prescribed amount may vary.

Ampule solution dosage

Children over six, teenagers and adults are typically prescribed one ampule containing 300 milligrams of Tobramycin to be inhaled via nebulizer twice per day, at least 6 hours apart, for a 28 day period. Stop using Tobramycin for 28 days to complete the cycle. Repeat the cycle with the same dose for 28 days once again.

Children who are younger than six will have the dose, frequency and duration of treatment with Tobramycin prescribed specifically for them by their health care provider.

Capsule dosage

Children over six, teenagers and adults will most likely be prescribed a dosage of four capsules of 28 milligrams each to be inhaled two times per day, at least 6 hours apart, for a 28 day period via nebulizer. Again, the dosage cycle should be observed, repeating the cycle once. Like the ampule solution prescription, for children less than six, their treatment regimen will be prescribed specifically for them by their physician.

Dosage with other medicines

Typically patients with cystic fibrosis will have other nebulizer treatments in addition to Tobramycin. These treatments should be continued using the separate nebulizer. Do not put any other medications in the nebulizer while you are using Tobramycin. A clean nebulizer should be used for other medications, which should be taken prior to your Tobramycin treatment.

Doses of Tobramycin that are missed should be taken as soon as you remember unless it is nearly time for the next treatment. In that case, the missed dose should be skipped to avoid doubling up your doses and creating a potentially dangerous overdose situation. Return to your normal dosing schedule as soon as possible.

Interactions

It is of critical importance that your disclose your full medical history as well as details of any drugs you are currently taking or have taken in the recent past before you begin a course of drug therapy treatment with Tobramycin or any other drug. This will ensure the safety of the drug treatment therapy as well as increase the effectiveness of the Tobramycin on your infection.

Include any and all prescription as well as non-prescription medications you’re taking including details of any vitamin, herbal or holistic supplements or treatments you are currently taking or have taken for past health reasons.

Tobramycin has been known to have interactions with the following common medications:

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

Use of Tobramycin with these medications is typically not recommended but may be unavoidable; in that case, dosage and frequency of either or both medications will be adjusted by your health care provider to insure effective, safe treatment.

In the case of the following drugs, using them with Tobramycin may increase the risk of certain side effects:

  • Cisplatin
  • Cyclosporine

Medical interactions

Certain medical problems may affect the safety or effectiveness of Tobramycin or worsen the symptoms of these conditions. Disclosing your full medical history is of primary importance before being treated with this and other drugs. Inform your doctor especially if you’ve been diagnosed or experienced the symptoms of:

  • Antibiotic allergy
  • Breathing problems
  • Bronchospasm
  • Kidney problems
  • Myasthenia gravis
  • Parkinson’s disease
  • Problems with hearing or balance

Warnings

Conditions such as hearing loss or a loss of equilibrium can be experienced in individuals who are genetically susceptible to ototoxic substances such as aminoglycoside, which Tobramycin is classified as. This ototoxicity is irreversible. It is important to inform your physician if you’ve had hearing or equilibrium problems or have been diagnosed as susceptible to ototoxicity. If you have changes of any kind in hearing such as ringing in the ears or other symptoms such as nausea, vomiting, headaches or dizziness during treatment with Tobramycin, inform your health care professional immediately.

Tobramycin is also nephrotoxic, which means it can damage or destroy kidney tissue. Patients are advised to adequately hydrate themselves during treatment and be certain to follow dosage instructions. If you exhibit signs of kidney damage such as an increased frequency of urination, blood in urine, difficulty breathing, swelling of feet and legs, increased thirst, or muscle weakness, report these to your doctor immediately.

Expect to be regularly examined by your physician while being treated with Tobramycin, including blood and urine testing for any unwanted side effects. You may also receive a hearing test during your office visits. Inform your doctor if you have diminished kidney function or kidney disease or have any hearing or equilibrium issues as these conditions could worsen under treatment of Tobramycin and lead to irreversible consequences.

Use of Tobramycin in women who are pregnant is not recommended as it could harm your unborn baby. It is advised that women of child bearing age use effective forms of birth control to avoid pregnancy during this treatment regimen. If you become pregnant while being treated with Tobramycin, inform your doctor immediately.

When using this medicine via nebulizer, it may cause you to experience bouts of coughing or have shortness of breath. If these conditions linger after use of Tobramycin, inform your doctor immediately or if you experience any pain or feel tight in the chest area.

If the effectiveness of your other medications has diminished while you’re taking Tobramycin, inform your doctor immediately. Do not alter the dosage of this medication or discontinue any medications without consulting your physician.

Storage

Ampule solution storage

Tobramycin in the ampule solution form should be stored in the refrigerator but not allowed to freeze. If you are unable to store Tobramycin in the refrigerator, keep it in its original foil pouch at room temperature and away from excessive heat or direct sunlight. Tobramycin that is kept at room temperature should be discarded after 28 days.

Capsule storage

Storage of Tobramycin capsules should be at room temperature away from heat and direct sunlight.

Both forms of Tobramycin should be stored out of sight and reach of children. Any unused or expired medication should be disposed of following the safety practices your health care provider or pharmacist can provide you with.

Summary

Tobramycin is an aminoglycoside antibiotic prescribed by doctors to treat bacterial infections, particularly gram-negative pseudomonas such as found in lung infections of cystic fibrosis patients. Tobramycin works by attacking the cell synthesis operation, eventually killing the bacterial cells themselves. Tobramycin does not affect cystic fibrosis itself, which is an incurable, genetic condition.

Tobramycin is available in liquid format, which is contained in an ampule, or in a capsule format. Both formats are intended to be used only with a device called a nebulizer. A nebulizer extracts the contents of the ampule or capsule and distributes it into the lungs when the patient inhales the fine mist it creates.

Doses of Tobramycin vary and are based on patient age, body weight and overall health condition as well as symptoms. Patients are encouraged to stick with the 28 days of treatment followed by 28 days off treatment regime before repeating the course. Depending on how the patient reacts to the treatment, the dosage may be changed by the doctor.

Tobramycin is known to have side effects that range from bloody nose, difficulty breathing, fever, voice changes and other respiratory effects. These effects are typically not severe and most disappear when treatment is completed. If any hearing loss or ringing in the ears is experienced or if any painful, bloody or frequent urination symptoms arise, it is advised that the patient inform their health care provider immediately, as these symptoms could be the sign of serious side effects.

Pregnant women, women who may become pregnant or breastfeeding mothers are advised not to be treated with Tobramycin.

Missed doses should be skipped if it is close to the time for the next dose to avoid potentially dangerous overdose situations. If you exhibit signs of overdose such as blue lips, fingernails or skin, dizziness, drowsiness, feeling of movement or spinning or breathing difficulties, inform your doctor immediately.

Using Tobramycin with other medications for symptoms of cystic fibrosis is typically safe and effective if you follow your doctor’s instructions on when to take each medication. Typically, you will be advised to take Tobramycin last. If you experience any diminished effectiveness of either medication, contact your doctor immediately.

Store Tobramycin ampules in the refrigerator, if possible, and the capsules at room temperature, away from heat and light and out of sight and reach of children. Expired or unused medication should be disposed of safely according to instructions provided to you by your physician or pharmacist.

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Last Reviewed:
December 24, 2017
Last Updated:
December 22, 2017
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