Tobramycin

Tobramycin

File:Tobramycin vector.svg
Clinical data
Pregnancy category	D (Injection, Inhalation); B (Ophthalmic) (US)
Routes of administration	IV, IM, inhalation, ophthalmic
ATC code	J01GB01 (WHO) S01AA12 (WHO)
Pharmacokinetic data
Protein binding	< 30%
Elimination half-life	Neonates < 1200 g: 11 hrs; > 1200 g 2-9 hrs Adults: 2-3 hours; longer with impaired renal function
Identifiers
IUPAC name 4-amino-2-[4,6-diamino-3- [3-amino-6-(aminomethyl) -5-hydroxy-tetrahydropyran-2-yl]oxy- 2-hydroxy-cyclohexoxy]-6-(hydroxymethyl) tetrahydropyran-3,5-diol
CAS Number	32986-56-4
PubChem CID	5496
DrugBank	APRD00582
E number	{{#property:P628}}
ECHA InfoCard	{{#property:P2566}}
Chemical and physical data
Formula	C18H37N5O9
Molar mass	467.515 g/mol

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Tobramycin sulfate is an aminoglycoside antibiotic used to treat various types of bacterial infections, particularly Gram-negative infections.

Mechanism of action

Tobramycin works by binding to a site on the bacterial 30S and 50S ribosome, preventing formation of the 70S complex. As a result, mRNA cannot be translated into protein and cell death ensues.

Administration

Like all aminoglycosides, tobramycin does not pass the gastro-intestinal tract, so for systemic use it can only be given intravenously or intramuscularly. This formulation for injection is branded Nebcin®. Patients with cystic fibrosis will often take an inhalational form (Tobi®) for suppression of Pseudomonas aeruginosa infections. Tobramycin is also combined with dexamethasone as an ophthalmic solution (TobraDex®).

Bausch & Lomb Pharmaceuticals, Inc. makes a sterile Tobramycin Ophthalmic Solution (eye-drops) with a tobramycin concentration of 0.3%, which is available by prescription only in the United States and Canada. (In some countries, such as Italy, it is available over the counter.) It is mixed with 0.01% benzalkonium chloride as a preservative. These concentrations result in 3 mg per ml and 0.1 mg per ml, respectively.

Side effects

Like other aminoglycosides, tobramycin can cause deafness or a loss of equilibrioception (vertigo) in genetically susceptible individuals. These individuals have a normally harmless mutation in their DNA, that allows the tobramycin to affect their cells. The cells of the ear are particularly sensitive to this.

Tobramycin can also be highly toxic to the kidneys, particularly if multiple doses accumulate over a course of treatment.

For these reasons, when tobramycin is given parenterally, it is usually dosed by body weight. Various formulae exist for calculating tobramycin dosage. Also serum levels of tobramycin are monitored during treatment.