Doses - TOBRAMYCIN SULFATE
Note: There is significant inter-patient variability with regards to aminoglycoside pharmacokinetic parameters. To insure therapeutic levels and to minimize the risks for toxicity development, it is recommended to consider monitoring serum levels for this drug.
For small animals, one pair of authors (Aronson and Aucoin 1989) make the following recommendations with regard to minimizing risks of toxicity, yet maximizing efficacy:1) Dose according to animal size. The larger the animal, the smaller the dose (on a mg/kgbasis). 2) The more risk factors (age, fever, sepsis, renal disease, dehydration) the smaller the dose. 3) In old patients or those suspected of renal disease, increase dosing interval from q8h toq16-24h. 4) Determine serum creatinine prior to therapy and adjust by changes in level even if itremains in "normal range". 5) Monitor urine for changes in sediment (e.g., casts) or concentrating ability. Not veryuseful in patients with UTI. 6) Therapeutic drug monitoring is recommended when possible.Dogs & Cats:
a) 2 mg/kg IV, IM, or SubQ q8h (avoid use or reduce dosage in patients with renal failure;recommend therapeutic drug monitoring, particularly in young animals) (Vaden and Papich 1995)Horses:
For susceptible infections: 1 - 1.7 mg/kg q8h IV (slowly) or IM (Note: This is a human doseand should be used as a general guideline only) (Walker 1992)Birds:
For susceptible infections:
a) 5 mg/kg IM every 12 hours (Bauck and Hoefer 1993)Reptiles:
For susceptible infections:
a) 2.5 mg/kg once daily IM (Gauvin 1993)
Monitoring Parameters - 1) Efficacy (cultures, clinical signs and symptoms associated with infection); 2) Renal toxicity; baseline urinalysis, serum creatinine/BUN. Casts in the urine are oftenthe initial sign of impending nephrotoxicity. Frequency of monitoring during therapy is controversial. It can be said that monitoring daily urinalyses early in the course of treatment or dailycreatinines once casts are seen or increases are noted in serum creatinine levels are not too frequent;
3) Gross monitoring of vestibular or auditory toxicity is recommended; 4) Serum levels if possible;see the reference by Aronson and Aucoin in Ettinger (Aronson and Aucoin 1989) for moreinformation.
Client Information - With appropriate training, owners may give subcutaneous injections athome, but routine monitoring of therapy for efficacy and toxicity must still be done. Clients shouldalso understand that the potential exists for severe toxicity (nephrotoxicity, ototoxicity) developingfrom this medication.
Dosage Forms/Preparations/FDA Approval Status - Veterinary-Approved Products: None
Tobramycin Sulfate Powder for Injection: 30 mg/ml in 1.2 g vials Nebcin® (Lilly); Generic (Rx)
Also available in ophthalmic preparations.
For small animals, one pair of authors (Aronson and Aucoin 1989) make the following recommendations with regard to minimizing risks of toxicity, yet maximizing efficacy:
Dogs & Cats: 
a) 2 mg/kg IV, IM, or SubQ q8h (avoid use or reduce dosage in patients with renal failure;recommend therapeutic drug monitoring, particularly in young animals) (Vaden and Papich 1995)Horses: 
For susceptible infections: 1 - 1.7 mg/kg q8h IV (slowly) or IM (Note: This is a human doseand should be used as a general guideline only) (Walker 1992)Birds: 
For susceptible infections: a) 5 mg/kg IM every 12 hours (Bauck and Hoefer 1993)
Reptiles: 
For susceptible infections: a) 2.5 mg/kg once daily IM (Gauvin 1993)
Monitoring Parameters - 1) Efficacy (cultures, clinical signs and symptoms associated with infection); 2) Renal toxicity; baseline urinalysis, serum creatinine/BUN. Casts in the urine are oftenthe initial sign of impending nephrotoxicity. Frequency of monitoring during therapy is controversial. It can be said that monitoring daily urinalyses early in the course of treatment or dailycreatinines once casts are seen or increases are noted in serum creatinine levels are not too frequent;
3) Gross monitoring of vestibular or auditory toxicity is recommended; 4) Serum levels if possible;see the reference by Aronson and Aucoin in Ettinger (Aronson and Aucoin 1989) for moreinformation.
Client Information - With appropriate training, owners may give subcutaneous injections athome, but routine monitoring of therapy for efficacy and toxicity must still be done. Clients shouldalso understand that the potential exists for severe toxicity (nephrotoxicity, ototoxicity) developingfrom this medication.
Dosage Forms/Preparations/FDA Approval Status - Veterinary-Approved Products: None
Human-Approved Products:
Tobramycin Sulfate Injection 10 mg/ml in 6 & 7 ml vials and 40 mg/ml in 1.5 & 2 ml syringesand 2 & 30 ml vials ; Nebcin® (Lilly); Generic; (Rx)Tobramycin Sulfate Powder for Injection: 30 mg/ml in 1.2 g vials Nebcin® (Lilly); Generic (Rx)
Also available in ophthalmic preparations.