From the Guidelines
The standard dosage for tobramycin inhaled solution is 300 mg administered twice daily in alternating cycles of 28 days on medication followed by 28 days off medication, as recommended for patients with cystic fibrosis and Pseudomonas aeruginosa infection 1. This dosage is based on the guidelines for the management of cystic fibrosis and is intended to improve lung function, reduce exacerbations, and enhance quality of life.
- The medication should be administered after completing other airway clearance therapies.
- Each dose should be taken approximately 12 hours apart, and not less than 6 hours apart.
- The medication comes in single-use ampules that should be used with an appropriate nebulizer system as directed by your healthcare provider.
- For tobramycin inhalation powder (TOBI Podhaler), the typical dose is four 28 mg capsules (112 mg total) inhaled twice daily using the Podhaler device, also in alternating 28-day on/off cycles.
- Tobramycin works by directly targeting Pseudomonas aeruginosa bacteria in the lungs, which commonly infect patients with cystic fibrosis or bronchiectasis.
- The cyclic dosing regimen helps prevent bacterial resistance while providing periods of reduced medication burden.
- Common side effects include voice alteration, tinnitus, and cough.
- Kidney and hearing function should be monitored during treatment, as recommended by the guidelines for the management of cystic fibrosis 1.
From the FDA Drug Label
The recommended dose of TOBI Podhaler is the contents of 4 capsules inhaled by mouth 2 times each day. Doses should be inhaled as close to 12 hours apart as possible and not less than 6 hours apart. The recommended dosage of Tobramycin inhaler is to inhale the contents of 4 capsules by mouth, 2 times a day.
- The doses should be taken as close to 12 hours apart as possible.
- The doses should not be taken less than 6 hours apart 2.
From the Research
Tobramycin Inhaler Dosage
- The dosage of tobramycin inhaler can vary depending on the specific treatment regimen and patient population.
- A study published in the American Journal of Respiratory and Critical Care Medicine in 2003 found that 300 mg of tobramycin solution for inhalation administered twice daily for 28 days was safe and effective in reducing lower airway Pseudomonas aeruginosa density in young children with cystic fibrosis 3.
- Another study published in the Journal of Cystic Fibrosis in 2013 compared the efficacy of aztreonam for inhalation solution and tobramycin nebulizer solution in cystic fibrosis patients with airway Pseudomonas aeruginosa, and found that aztreonam was superior to tobramycin in improving lung function and reducing respiratory hospitalizations 4.
- A Cochrane review published in 2022 found that inhaled antibiotics, including tobramycin, may improve lung function and reduce the frequency of exacerbations in people with cystic fibrosis, but the certainty of the evidence was generally low due to the risk of bias and imprecision in the included trials 5.
- The dosage of tobramycin used in these studies was typically 300 mg twice daily, although other regimens have also been investigated, such as 300 mg 12-hourly in combination with aztreonam 75 mg 8-hourly 6.
- In vitro studies have also investigated the effects of tobramycin and aztreonam on Pseudomonas aeruginosa biofilms, and found that the combination of the two antibiotics may be beneficial in eliminating susceptible strains 7.