From the Guidelines
The recommended dose of tobramycin nebulizer solution is 300 mg administered twice daily in alternating cycles of 28 days on and 28 days off therapy, as this regimen has been shown to be safe and effective in improving lung function and reducing hospitalizations in patients with cystic fibrosis 1. This dose is supported by a European consensus on antibiotic therapy against Pseudomonas aeruginosa in cystic fibrosis, which found that tobramycin 300 mg b.i.d. on alternative months is safe over a two-year period 1.
Key Considerations
- The solution should be administered using an appropriate nebulizer device, and each treatment typically takes about 15-20 minutes to complete.
- Patients should use a bronchodilator before tobramycin if prescribed, and the tobramycin solution should not be mixed with other medications in the nebulizer.
- Tobramycin works by directly targeting the bacteria in the lungs, achieving high local concentrations while minimizing systemic absorption and toxicity.
- Common side effects include voice alteration, tinnitus, and increased cough.
- Renal function should be monitored periodically during treatment, especially in patients with pre-existing kidney disease.
Administration and Monitoring
- The nebulizer should produce particles in the range of 2-5 mm in order to reach the smaller bronchioles.
- Aerosol administration of 400 mg or 600 mg tobramycin did not lead to audiometric abnormalities or renal toxicity in CF patients 1.
- Serum aminoglycoside concentrations should be monitored in patients given high doses, as tobramycin levels in serum samples of CF patients may vary considerably after aerosol treatment 1.
From the Research
Tobramycin Nebuliser Dose
- The recommended dose of tobramycin nebuliser solution is 300 mg/4 mL, administered twice daily for 28 days, followed by a 28-day off period 2.
- This dose has been shown to improve lung function and reduce sputum Pseudomonas aeruginosa density in patients with cystic fibrosis 2.
- The use of tobramycin nebuliser solution has also been studied in younger children, with no detectable renal toxicity or ototoxicity observed 3.
- Different nebulisers, such as the PARI eFlow and PARI LC Plus, can be used to administer tobramycin nebuliser solution, with similar pharmacokinetic profiles and safety profiles observed 4.
Administration and Pharmacokinetics
- Tobramycin nebuliser solution can be administered using different nebulisers, with the PARI eFlow nebuliser resulting in significantly shorter nebulisation times compared to the PARI LC Plus nebuliser 4.
- The pharmacokinetic profile of tobramycin nebuliser solution has been studied, with similar plasma and sputum concentrations observed after administration using different nebulisers 4.
- The use of systemic aminoglycosides, including tobramycin, has been associated with potential toxicity, including nephrotoxicity and ototoxicity, although the risk of these adverse effects can be minimized with appropriate dosing and monitoring 5, 6.