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Tobramycin is an aminoglycoside antibiotic produced by the actinomycete Streptomyces tenebrarius. It has a bactericidal effect, that is, it causes the death of a pathogenic microorganism. In clinical practice, it is used to treat infections caused by gram-positive and gram-negative bacteria.

Synonyms Russian

Aminoglycosides, antibiotic.

English synonyms

Tobramycin.

Research method

High performance liquid chromatography with tandem mass spectrometry.

Units

mcg/ml (micrograms per milliliter).

What biomaterial can be used for research?

Venous blood.

How to properly prepare for research?

Children under 1 year of age should not eat for 30-40 minutes before the test.
Do not eat for 2-3 hours before the test; you can drink clean still water.
Do not smoke for 30 minutes before the test.

General information about the study

Tobramycin is a water-soluble aminoglycoside, broad-spectrum antibiotic produced by Streptomyces tenebrarius and used in clinical practice since 1975. It inhibits the growth of gram-negative and gram-positive microorganisms. Most active against Staphylococcus spp., including Staphylococcus aureus and Staphylococcus epidermidis, incl. penicillin-resistant strains, Citrobacter spp., some species of Streptococcus spp., Pseudomonas aeruginosa, Escherichia coli, Klebsiella pneumoniae, Enterobacter aerogenes, Morganella morganii, Proteus mirabilis, most strains of Proteus vulgaris, Haemophilus influenzae, Haemophilus aegyptius, Moraxella lacunata, Acinetobacter calcoacetic us, some types Neisseria.

The mechanism of action of tobramycin is irreversible binding to one of the two binding sites on the 30S ribosomal subunit, thereby inhibiting the synthesis of bacterial proteins, which ultimately leads to a change in the permeability of the cell membrane and cell death. Tobramycin also destabilizes the bacterial membrane by binding to 16 S rRNA.

Available dosage forms of tobramycin are liquid for intravenous or ophthalmic use, ointment for ophthalmic use, solution, and powder form for inhalation use. Tobramycin can be administered intravenously, intramuscularly, or by inhalation. The drug is effective both when administered systemically and by inhalation. Like all aminoglycosides, tobramycin has ototoxic and nephrotoxic effects, therefore, monitoring of kidney function and hearing tests are required during drug therapy.

What is the research used for?

To determine the concentration of the drug in the blood.
To select an individual dosage of the drug.
To optimize treatment control through dose adjustments.
To assess drug interactions.
To diagnose overdose.
To identify violations of the drug regimen.
To prevent the toxic effect of the drug.

When is the study scheduled?

When prescribing tobramycin for the treatment of infections sensitive to this drug.
If necessary, determine the concentration of the drug and monitor its fluctuations in the blood.
If the effectiveness of the drug used is insufficient and the issue of dose adjustment is decided.
When changing the dosage and dosage form of the drug.
If a drug overdose is suspected.

What do the results mean?

Reference values: 4 - 10 µg/ml.

The therapeutic concentration is 4-10 mcg/ml.

The results of the study are assessed by the attending physician taking into account the dose of tobramycin, its regimen, the patient’s age, concomitant pathology and individual tolerability of the drug.

What can influence the result?

The concentration of tobramycin in the blood serum can be changed by its simultaneous administration with diuretics, or its use with another aminoglycoside.
Impaired renal function may lead to accumulation of tobramycin and create toxic serum levels.

Chemical properties

This substance belongs to the group of broad-spectrum aminoglycoside antibiotics The compound is a metabolic product of the actinomycete Streptomyces tenebrarius.

Molecular mass of the substance = 467.5 grams per mole. The product is highly soluble in water, poorly soluble in ethyl alcohol , and almost insoluble in ether and chloroform . In preparations it is most often found in the form of Tobramycin Sulfate , molecular weight of sulfate = 1425 g per mole.

The product is produced in the form of injection solutions of various concentrations; sterile powder for preparing solutions; eye ointment 0.3%; solution for inhalation administration.

Indications for use

The chemical compound is included in solutions for intramuscular and intravenous administration:

for the treatment of infectious diseases caused by microorganisms sensitive to the action of antibiotics (biliary tract, joints, bones, central nervous system, abdominal cavity, respiratory organs, skin, soft tissues, bile and urinary tract);
after surgical interventions for the prevention or treatment of various inflammatory processes;
for sepsis .

Tobramycin for eyes, in drops and gels, is used for bacterial eye infections: blepharitis, keratoconjunctivitis, keratitis, conjunctivitis, blepharoconjunctivitis, iridocyclitis .

Inhalations with Tobramycin are prescribed:

for the treatment of respiratory tract infections caused by Pseudomonas aeruginosa ;
children over 6 years old with cystic fibrosis .

Side effects

If you experience prolonged discomfort while using Tobrex eye drops, you should report this to your doctor. This medication helps most people with eye infections, but may cause unwanted side effects in some patients. All medications can cause side effects. Sometimes they are serious, but most of the time they are not. Medical treatment may be needed to relieve some side effects.

One possible side effect is red eyes.

A list of some side effects during treatment with Tobrex drops, however most people do not experience them:

eye irritation or feeling of a foreign object in the eye;
inflammation of the cornea;
punctate keratitis;
swollen/itchy eyelids;
redness of the eyes.

These are the most common cases of side effects of the drug. Usually they are not mild and last a long time. However, if any of the following occur, you should stop taking the medicine and consult a doctor:

skin rash;
swelling of the face, arms, or legs;
shortness of breath, difficulty breathing;
severe and sudden onset of complications;
pinkish, itchy swellings on the skin, also called hives;
shortness of breath (shortness of breath, heart failure).

These hypersensitivity reactions can be very serious side effects. Urgent medical attention or hospitalization may be required. But such side effects are very rare.

Additional side effects that may occur while taking the drug include:

eyelash loss;
skin lightening.

Their occurrence should be reported to your doctor. The drug can be stored in the refrigerator, without freezing. Storage in places that are dirty, damp, poorly ventilated, etc. should be avoided at all costs.

In certain cases, it is possible to replace Tobrex with gentamicin, but the decision about this possibility must be made by the doctor. Preparations intended for the treatment of eye infections containing tobramycin as an active substance are also known under the names Tobrimed, Tobrin or Tobrosopt.

There is no evidence that Tobrex drops are addictive.

Drug interactions Tobramycin

With the simultaneous use of tobramycin with nephro- and ototoxic drugs, the severity of its side effects increases. If such combinations are necessary, the concentration of drugs in the blood plasma should be monitored. The specific toxic effects of tobramycin may be increased when taking loop diuretics (furosemide, ethacrynic acid). Inhibition of neuromuscular transmission increases with simultaneous use with neuromuscular blockers, general anesthetics, polymyxin, as well as with massive transfusion. Tobramycin may enhance the inhibition of respiratory center function by narcotic analgesics.

Reviews of Tobramycin

Reviews about the use of the antibiotic are good, the drug is quite effective, serious adverse reactions occur infrequently.

Some reviews about the drug:

“... While playing, my daughter injured her eye and fell on a toy. It turned out that nothing particularly bad had happened; they prescribed eye drops with an antibiotic. After each instillation, the daughter became capricious and cried, apparently stinging from the drops. The medicine is good, it helped, there were no complications, no discharge, no pus”;
“... Throughout the entire course of treatment with Tobramycin, after the injections I felt a little dizzy and had no appetite. However, these symptoms did not bother me much. The main thing is that I punctured the entire course and was cured”;
“... I had conjunctivitis . I suffered for a long time and tried to treat it with folk remedies. The doctor prescribed this antibiotic. I was very happy when relief came after the first use. Cured conjunctivitis completely.”

Interaction

Furosemide and ethacrynic acid , when combined with the substance, lead to increased ototoxicity of the drugs.

The solution for parenteral use should not be mixed in a dropper or syringe with other medications.

When Tobramycin is taken in combination with aminoglycosides, cephalosporins and polypeptide antibiotics, the load on the kidneys increases.

The drug enhances the neurotoxicity of vancomycin .

Tobramycin, when combined with muscle relaxants , in particular tubocurarine , enhances their muscle-relaxing effect.

Contraindications

The medicine is not prescribed:

in case of hypersensitivity to this antibiotic or group of aminoglycosides ;
patients with renal failure;
with neuritis of the auditory nerve ;
pregnant women;
for disorders in the functioning of the brain caused by insufficient function of the 8th pair of cranial nerves .

The drug is used with caution:

in elderly patients;
for botulism ;
in patients with myasthenia gravis or Parkinson's disease ;
with severe dehydration of the body;
while breastfeeding.

special instructions

If the patient has previously experienced hypersensitivity reactions to a group of aminoglycosides , then there is a high probability of developing allergic reactions to Tobramycin.

Reversible or complete deafness due to treatment with the drug may appear after the end of treatment. During therapy with the drug, it is recommended to monitor the patient’s general condition, kidney function, levels of calcium, creatinine , protein in the urine, sodium and magnesium in the blood plasma, and conduct audiometric tests .

Sometimes dosage adjustment is required in special groups of patients (pregnant women, peritonitis and burns, persons with high cardiac output or glomerular function).

It should be remembered that long-term use of the substance leads to the development of superinfections , most often mycoses .

It is recommended to take a 5-minute break between instilling this product and any other drug in the form of eye drops.

Compound

Tobramycin is an "aminoglycoside" antibiotic. Active Ingredient:

tobramycin (3.0 mg/ml)

Other Ingredients:

benzalkonium chloride (0.1 mg/ml) as a preservative;
boric acid;
sodium sulfate;
sodium chloride;
tyloxapol sodium hydroxide and/or sulfuric acid (to adjust pH levels);
purified water.

Before using eye drops, you should consult your doctor

Overdose of the drug Tobramycin, symptoms and treatment

Acute poisoning with tobramycin can develop if the administered daily dose exceeds 5 mg/kg in adults and 7.5 mg/kg in children. Signs of poisoning: auditory and vestibular disorders, neuromuscular blockade up to the development of paralysis of the respiratory muscles (especially in patients with myasthenia gravis and epilepsy), kidney damage. Treatment of poisoning includes the administration of calcium salts for neuromuscular blockade, ensuring effective ventilation of the lungs, and with the development of acute renal failure - hemodialysis.

List of pharmacies where you can buy Tobramycin:

Moscow
Saint Petersburg

Side effects

When used systemically, the following adverse reactions may occur:

diarrhea , liver problems, increased levels of liver enzymes or bilirubin ;
vomiting, nausea, polyuria , thirst, oliguria , proteinuria , increased levels of urea and creatinine , frequent or infrequent urination, dizziness;
proteinuria, disorders of tubular secretion;
anemia , leukocytosis , thrombocytopenia, leukopenia, granulocytopenia ;
damage to the vestibular apparatus and hearing, deafness, vertigo , tinnitus;
headaches, drowsiness, convulsions , disturbances in the orientation of movements;
paresthesia , hypocalcemia , deficiency of sodium and magnesium in the blood;
rashes and itching on the skin, hyperemia , fever , eosinophilia , Quincke's edema , other allergic reactions .

After inhalation, the likelihood of developing:

ulcerative lesions of the oral cavity, fungal infections;
shortness of breath, bronchospasm , nosebleeds;
runny nose , voice changes, cough, pharyngitis , laryngitis ;
sinusitis , hyperventilation , asthma , hypoxia .

When using the product in ophthalmic practice, local reactions occur:

itching, swelling and redness of the eyelids;
burning and pain during and after instillation or application of ointment;
blurred vision.