Tobramycin (When ATH S01AA12)

When ATH:
S01AA12

Characteristic.

Antibiotics aminoglycoside. Producing actinomycete Streptomyces tenebrarius. Easily soluble in water (1:1,5). Very slightly soluble in ethanol (1:2000). Practically insoluble in chloroform, ether.

Pharmacological action.
Broad-spectrum antibacterial, bactericide.

Application.

For systemic use: infectious diseases, caused by sensitive microflora - biliary tract infections, bone and joints (incl. osteomyelitis), CNS (incl. meningitis), infection of the abdominal cavity (incl. peritonitis), Respiratory (incl. pneumonia, empyema, lung abscess), infections of skin and soft tissue (incl. infected burns), urinary tract (incl. pyelonephritis, pyelitis, cystitis), sepsis, postoperative infections.

In ophthalmology: bacterial infections of the eye and its appendages, due to the sensitive microflora, incl. .Aloe, conjunctivitis, keratokonъyunktyvyt, blefarokonъyunktyvyt, keratit, iridocyclitis.

Contraindications.

Hypersensitivity, incl. other aminoglycosides; severe chronic renal failure, dysfunction of cranial nerve VIII, neuritis of the auditory nerve.

Restrictions apply.

Renal failure, botulism, myasthenia, parkinsonizm, degidratatsiya, advanced age.

Pregnancy and breast-feeding.

If you require the use of tobramycin in life-threatening conditions, or for the treatment of severe diseases in pregnant women in the event of the ineffectiveness of other drugs, necessary to compare the benefit to the mother and the potential risk to the fetus, tk. tobramycin is a full two-way irreversible congenital deafness and accumulates in the kidneys of the fetus.

Category actions result in FDA - D. (There is evidence of the risk of adverse effects of drugs on the human fetus, obtained in research or practice, However, the potential benefits, associated with drugs in pregnant, may justify its use, in spite of the possible risk, if the drug is needed in life-threatening situations or severe disease, when safer agents should not be used or are ineffective.)

Side effects.

When administered systemically

From the digestive tract: nausea, vomiting, diarrhea, abnormal liver function (increase in liver transaminases, LDH, bilirubin).

Cardio-vascular system and blood (hematopoiesis, hemostasis): anemia, leukopenia, leukocytosis, granulocytopenia, thrombocytopenia.

From the nervous system and sensory organs: ototoxicity - irreversible damage to the vestibular and auditory branches of the VIII pair of cranial nerves with partial or complete bilateral deafness, dizziness, vertigo, tinnitus; headache, disorientation, drowsiness, paraesthesia, Muscle fasciculations, convulsions.

With the genitourinary system: nephrotoxicity (oligurija, цilindrurija, proteinuria, tubular disorders, increases in serum creatinine and urea nitrogen, substantial increase or decrease in urinary frequency, polyuria, thirst).

Allergic reactions: itching, dermahemia, rash, fever, angioedema, eozinofilija.

Other: hypocalcemia, giponatriemiya, gipomagniemiya.

When used in ophthalmology - Local allergic reactions such as itching, redness, pripuhaniya century; burning sensation or burning pain; for eye ointment only (additionally) - Blurred vision.

Cooperation.

Increases neuro, th- and nephrotoxicity of other drugs. The probability of ototoxicity increases against the backdrop of loop diuretics (furosemid, ethacrynic acid). It enhances the effect of non-depolarizing muscle relaxants. It reduces the effect antimiastenicheskih funds. In / in the introduction of indomethacin reduces the renal clearance of tobramycin, increasing the concentration in blood and increasing T_1/2 (may require correction mode). Methoxyflurane increases the risk of side effects. Drugs for inhalation general anesthesia (halogenated hydrocarbons), narcotic analgesics, transfusion of large amounts of blood with citrate as anticoagulants preservatives, PM, blocking neuromuscular transmission, enhance neuromuscular blockade.

Overdose.

Symptoms: impairment of renal function, acute renal failure, auditory and vestibular disorders, neuromuscular block, paralysis of respiratory muscles; in ophthalmology - severe lacrimation, itch, redness or swelling of the eyes or eyelids, punctate keratitis.

Treatment: ensuring adequate ventilation and oxygenation, hydration (urine output of at least 3–5 ml/kg/h) under the control of the fluid balance, creatinine clearance, Tobramycin levels in plasma (must be carefully monitored to achieve plasma concentrations less than 2 ug / ml); hemodialysis (patients with T_1/2 more 2 h or impaired renal function).

Dosing and Administration.

/ M, I /, konъyunktyvalno. Adults and children over 1 year: A single dose - 1 mg / kg, daily - 3 mg/kg in three doses (every 8 no), maximum up to 5 mg / kg / day. Infants and children up to 1 years - 2–4 mg/kg/day in two doses, maximum daily - 5 mg / kg. The usual course duration is 5–10 days. For intravenous infusion, dilute in 100–200 ml of isotonic sodium chloride solution or 5% glucose solution, introduce drip for 20-60 minutes.

In ophthalmology. Eye drops - conjunctival, by 1 drop in the eye, 4-6 Times per day, in the acute stage - every hour. Ointment for ever and lay 2-3 times a day.

Precautions.

Patients, have hypersensitivity to other aminoglycosides, may be sensitive to tobramycin.

Patients should be under strict medical supervision due to the high potential risk of neurotoxic and nephrotoxic effects, recommended regularly audiometric tests. It will be appreciated, some patients irreversible partial or total deafness can be formed after the end of treatment. By increasing the volume of distribution of the drug (pregnancy, burns, peritonitis, retroperitoneal infection) to achieve the effective concentration dose should increase, and in critical conditions and in young patients with high cardiac output and glomerular filtration rate - increase the frequency of administration. Elderly patients and patients with renal failure is necessary to reduce the dose or increase the interval between doses. Displaying regular determination of serum creatinine, BUN, Calcium, sodium, magnesium plasma, the relative density of urine, Protein in the urine, urinary sediment.

Long-term topical application may result in superinfection, incl. fungal.

Tobramycin as eyedrops (solution) not intended for intraocular injection.

When instillation into the eye of two different drugs to prevent the effect of "washing out" between administrations is needed not less than 5-minute interval.

At night, in addition to the eye drop can be employed to provide an ophthalmic ointment longer contact with the drug.

With the development of hypersensitivity reactions tobramycin treatment should be discontinued.

Cooperation