化合物详情

Intravenous and intramuscular therapy with tobramycin is usually associated with no increase in rates of serum aminotransferase or bilirubin elevations. Only isolated case reports of acute liver injury with jaundice have been associated with aminoglycoside therapy including tobramycin, not all of which are very convincing. The hepatic injury is typically mixed but can evolve into a cholestatic hepatitis. The latency to onset is rapid, occurring within 1 to 3 weeks and is typically associated with skin rash, fever and sometimes eosinophilia. Recovery typically occurs within 1 to 2 months and chronic injury has not been described. Aminoglycosides are not mentioned in large case series of drug induced liver disease and acute liver failure; thus, hepatic injury due to tobramycin is rare if...

Administration of intravesical BCG should be avoided with tobramycin, as antibiotics can diminish the therapeutic efficacy of intravesical BCG.

Patients overdosed on tobramycin with normal renal function should be hydrated adequately to preserve urine output of 3 to 5 mL/kg/h. Fluid and electrolyte balance, creatinine clearance, and tobramycin serum concentrations should be monitored closely until the serum tobramycin concentration falls below 2 mcg/mL. Patients with a tobramycin elimination half-life exceeding 2 hours or impaired renal function may require aggressive therapy, including the potential benefit of hemodialysis. It is crucial to note that inhaled tobramycin can cause systemic toxicity in patients with renal dysfunction.

References: DOI:10.1016/j.drudis.2019.09.022

/SRP:/ Advanced treatment: Consider orotracheal or nasotracheal intubation for airway control in the patient who is unconscious, has severe pulmonary edema, or is in severe respiratory distress. Positive-pressure ventilation techniques with a bag valve mask device may be beneficial. Consider drug therapy for pulmonary edema ... . Consider administering a beta agonist such as albuterol for severe bronchospasm ... . Monitor cardiac rhythm and treat arrhythmias as necessary ... . Start IV administration of D5W TKO /SRP: "To keep open", minimal flow rate/. Use 0.9% saline (NS) or lactated Ringer's (LR) if signs of hypovolemia are present. For hypotension with signs of hypovolemia, administer fluid cautiously. Watch for signs of fluid overload ... . Treat seizures with diazepam or lorazepam...

Relevant published information was not found as of the revision date.