From the FDA Drug Label
Tobramycin for Injection, USP is supplied as a dry powder in a bulk package vial. Amikacin sulfate injection, USP is a semi-synthetic aminoglycoside antibiotic derived from kanamycin. Tobramycin sulfate, a water-soluble aminoglycoside antibacterial, drug derived from the actinomycete Streptomyces tenebrarius.
The brand name and generic of aminoglycosides in the US are:
- Tobramycin (generic)
- Amikacin (generic) Note that the provided drug labels do not contain information on brand names, only generic names are mentioned 1, 2, 1.
From the Research
Aminoglycosides available in the US include both generic and brand name formulations, with the main aminoglycosides used clinically being gentamicin, tobramycin, amikacin, streptomycin, neomycin, and paromomycin. These antibiotics work by binding to bacterial ribosomes and inhibiting protein synthesis, making them effective against many gram-negative bacteria and some gram-positive organisms. Gentamicin is commonly used for serious infections including sepsis, while tobramycin has particular activity against Pseudomonas aeruginosa. Amikacin is often reserved for resistant organisms as it maintains activity against many bacteria that have developed resistance to other aminoglycosides. Neomycin is primarily used topically or orally for bowel preparation.
Key Points
- The main aminoglycosides used clinically are gentamicin (brand name Garamycin), tobramycin (Tobrex, TOBI), amikacin (Amikin), streptomycin, neomycin (Neo-Fradin), and paromomycin (Humatin) 3.
- When administering aminoglycosides, monitoring of drug levels is essential due to their narrow therapeutic window, with potential for nephrotoxicity and ototoxicity 4.
- Dosing is typically weight-based and may require adjustment in patients with renal impairment.
- Once-daily dosing regimens are often preferred over traditional multiple daily dosing as they may reduce toxicity while maintaining efficacy 4.
Administration and Monitoring
- Aminoglycosides should be administered with caution, taking into account the patient's renal function and potential for toxicity.
- Monitoring of drug levels is crucial to minimize the risk of nephrotoxicity and ototoxicity.
- The choice of aminoglycoside and dosing regimen should be individualized based on the patient's specific needs and the susceptibility of the infecting organism.
Choice of Aminoglycoside
- Gentamicin is commonly used for serious infections including sepsis.
- Tobramycin has particular activity against Pseudomonas aeruginosa.
- Amikacin is often reserved for resistant organisms as it maintains activity against many bacteria that have developed resistance to other aminoglycosides 5.