- Treatment of documented or suspected infections caused by susceptible Gram (-) bacilli including Pseudomonas aeruginosa.
- IV Intermittent infusion: over 30 minutes
Gestational Age and Post-Natal Age
|Dose*||Therapeutic Drug Levels|
(< 36 weeks GA)
|0 - 14 days||< 28 weeks GA||3 mg/kg/dose Q24h||
Traditional Dosing (Pre and Post levels obtained after 48 hours if renal function remains normal)
|29 - 36 weeks GA||3.5 mg/kg/dose Q24h|
|> 14 days||< 28 weeks corrected GA||3 - 3.5 mg/kg/dose Q18h|
|> 29 weeks corrected GA||3 - 3.5 mg/kg/dose Q12h|
|Gestational Age and Post-Natal Age||Dose*||Therapeutic Drug Levels|
Term (> 37 weeks GA)
0 - 7 days
|3 - 3.5 mg/kg/dose Q18h||
(Pre and Post levels obtained after 48 hours if renal function remains normal)
|0 - 7 days (Abnormal Renal Function **, Acute HIE/Asphyxia)||3 mg/kg/dose x 1||Random Tobramycin level 24 hours after initial dose, if < 2.0 mg/L may repeat dose. Consult pharmacist for further dosing interval recommendations|
> 7 days
|5 mg/kg/dose Q24h||
Extended Interval Dosing (Preferred with normal renal function)
(Pre level only done prior to 3rd dose)
|2.5 mg/kg/dose Q8h||
Pre and Post levels obtained on Day 3. For dosage adjustment and timing of levels in renal impairment, consult pharmacist
* For frequency adjustment due to renal dysfunction, consult clinical pharmacist.
** This would include neonates with suspected, possible or confirmed hypoxic ischemic events, fluid imbalance, possible or suspected renal thrombosis, congenital renal anomalies or any other conditions that may be associated with transient or prolonged renal dysfunction.
- Hematologic: anemia, granulocytopenia, thrombocytopenia
- Otic: vestibular/auditory toxicity
- Renal: nephrotoxicity, increase risk with concurrent use of nephrotoxic drugs (eg. furosemide, indomethacin)
- Renal: serum creatinine, urea, urine output
- Therapeutic drug levels: see tables
** When checking level, administer next dose as scheduled. Do not wait for levels to be reported unless otherwise advised
IV intermittent infusion:
- Tobramycin 40 mg/mL (doses < 10 mg)
- Take 1 mL (40 mg) and add to 39 mL D5W
- Final concentration: 1 mg/mL
- Tobramycin 40 mg/mL (doses > 10 mg)
- Take 1 mL (40 mg) and add to 3 mL D5W or 0.9% NaCl
- Final concentration: 10 mg/mL
- Tobramycin 40 mg/mL
Take 1 mL (40 mg) and add to 39 mL D5W
Final concentration: 1 mg/mL
- Solutions Compatible: D5W, D10W, 0.9% NaCl, dextrose-saline combinations
- Y-site Compatible: acyclovir, dexmedetomidine, fentanyl, fluconazole, heparin (low concentrations of 0.5 to 1 unit/mL that are used to maintain IV line patency), hydromorphone, midazolam, milrinone, morphine, TPN (amino acids- dextrose)
- Incompatible: heparin (concentration greater than 1 unit/mL), indomethacin, piperacillin/tazobactam, SMOF
- Direct contact of a penicillin antibiotic (eg, ampicillin, piperacillin) with an aminoglycoside (gentamicin, tobramycin) may cause inactivation. Rinse thoroughly between both administration if given via the same line.
Traditional Dosing: Intermittent dosing initially based on gestational and post-natal age. Dose modifications may be required based on pre and post levels obtained after 48 hours.
Extended Interval Dosing: Initial dosing based on Q24 hours schedule to achieve high peak levels in neonates > 7 days of age with no documented or possible abnormal renal function. Dosage modifications may be required based on pre-dose level obtained at 72 hours. This dosing is not to be used for preterm neonates.
-Taketomo CK, Hodding JH, Kraus DM. Pediatric and Neonatal Dosage Handbook 22nd Editions. Hudson: Lexi-Comp Inc.; 2015
- Low YS, Tan SL, Wan A. Extended-Interval Gentamicin Dosing in Achieving Therapeutic Concentrations in Malaysian Neonates. J Pediatr Pharmacol Ther. 2015. Mar-Apr, 20 (2): 119-127
-American Society on Health-System Pharmacists (ASHP). Handbook on Injectable Drugs. 19thEdition. Bethesda: American Society of Health-System Pharmacists; 2017