Tobramycin what group of antibiotics. Medicinal reference book geotar. Pharmacological properties, trade name

Tobramycin belongs to the group of aminoglycosides. Eye drops have an effective antibacterial effect.

It is mainly prescribed for the treatment of infectious lesions of the eyes.

The drug has several forms of release. Drops are for topical use only.. The tool has analogues with an identical composition.

Indications for use

These drops are designed to treat bacterial infections that affect the eyes and their appendages. Assign for the treatment of such diseases:

The drug has a pronounced medicinal effect. Can only be used after a doctor's prescription.

Price

The average cost of this drug in Russia starts from 160 rubles.

Compound

The active ingredient in eye drops is tobramycin.

In addition, the composition contains additional substances: sodium chloride, disodium edetate, hypromellose, benzalkonium chloride and purified water. Before use, be sure to study the composition of the drug.

Instructions for use

The original package leaflet describes the correct use. The medicine is instilled into the conjunctival sac, 2 drops every 4 hours. The course of drug therapy lasts 7-10 days. If necessary, the doctor can reduce or extend this period. It depends on the individuality of the organism and the complexity of the infection.

If the infection is accompanied by severe complications, then the drops should be used every hour.. When the symptoms begin to decrease, the dosage is reduced to the standard amount. When using the medicine as a prophylaxis, 1 drop is instilled into each eye 4 times a day. Gradually, the dosage should be reduced. Such a scheme should be selected by the attending physician.

With extreme caution, the drug is prescribed to elderly patients and in the presence of such pathologies: Parkinson's syndrome, botulism, myasthenia gravis, dehydration, acute renal and hepatic failure.

It is forbidden to exceed or reduce the prescribed dose on your own. This may adversely affect the healing effect.. If there is no result, you should consult a doctor. In some cases, it may be necessary to replace the product with a safe analogue.

children

The drug can be prescribed to children older than 1 year. The dosage should be clearly less than for adults. The safe dose should be determined by the doctor, taking into account the age, weight, complexity of the infection in the patient. Self-medication in such cases is strictly prohibited.

special instructions

This medicine contains benzalkonium chloride. Given this, patients who wear contact lenses should remove them before instillation. Can be put on only 15 minutes after instillation. After instillation, redness, itching, burning and clouding may occur.

With the development of such symptoms, it is not recommended to drive vehicles, work with machinery and mechanics, and other areas where concentration of vision and attention is required. It is important to consider that prolonged use of drops can provoke the development of a fungal infection. Eye drops are not intended for intraocular injection.

When using several eye drops, the interval between doses should be at least 15 minutes. At night, you can additionally use the ointment to enhance the medicinal effect. It is designed for longer use. If during the period of drug therapy hypersensitivity to the active substance begins to develop, then treatment should be discontinued.

Interaction with other drugs

When taken simultaneously with drugs that contain methoxyflurane, there may be a risk of increased adverse reactions.. Toxic effects on the kidneys can occur when interacting with diuretics, other antibiotics of the aminoglycoside group, polymyxin, vancomycin and cephalosporin.

A decrease in drug action is observed with simultaneous use with beta-lactam antibiotics.. Some muscle relaxants may enhance the effect of the drug. Therefore, such information should be clarified with the attending ophthalmologist.

Pregnancy and lactation

During pregnancy, this drug can only be used under medical supervision.. It is prescribed only in case of urgent need, taking into account the benefits for the woman and the risk to the health and development of the fetus.

This drug is not recommended during lactation. In case of urgent need for drug therapy, the child should be transferred to artificial nutrition. Lactation should be completely interrupted.

Side effects

Adverse reactions mainly appear against the background of the development of hypersensitivity to the active substance. This is manifested by such symptoms:

• prolonged and spontaneous lacrimation;
• eye redness;
• burning;
• swelling of the eyelids;
• sensation of sand or a foreign body in the eyes.

If such signs occur, the ophthalmologist should be informed. With the development of hypersensitivity, treatment with this drug should be discontinued. In this case, choose a safe analogue.

Contraindications

These eye drops have the following list of contraindications for use:

• hypersensitivity to antibacterial drugs of the aminoglycoside group;
• predisposition to allergic reactions;
• kidney failure;
• individual intolerance to the components in the composition;
• children's age up to 1 year;
• lactation.

If there are contraindications, the patient is strictly forbidden to take this medicine.. The development of hypersensitivity may develop with improper or prolonged use. To avoid such adverse reactions, you should strictly follow the doctor's recommendations.

Reviews of doctors

Reviews of doctors will help to study the effect of the medicine in more detail:

Elena, ophthalmologist: Drops have a pronounced antibacterial effect. I like its action even with severe infectious lesions. I prescribe to patients who are faced with blepharitis, keratitis and other bacterial diseases. Often prescribed as a complex therapy. When used correctly, adverse reactions are very rare.

Alexander, ophthalmologist: Tobramycin is one of the drugs that I often use in my practice. Drops produce a pronounced antibacterial effect. Effectively help even with severe lesions. Rarely prescribed to pregnant women and children. Patients rarely complain of adverse reactions. In general, the drug is well tolerated. In my experience, hypersensitivity and candidiasis developed several times during the course of treatment.

Tobradex is an ophthalmic drug of combined action, which is widely used in the treatment of various diseases of the organs of vision. It has a pronounced anti-inflammatory and bactericidal effect. The drug has actively established itself in pediatrics due to its gentle effect.

Tobradex is sold as a therapeutic eye solution. The active ingredient is tobramycin. In 1 ml of solution, it is contained in an amount of 3 mg. Additional components include:

• benzalkonium chloride,
• water for injection
• hypromellose,
• disodium edetate,
• sodium chloride,
• hydrochloric acid.

They sell drops in a plastic bottle. Its capacity is 5 ml. Equipped with a dropper and dispenser. The container is placed in a cardboard box. Storage of the drug should take place in a dark place, and the air temperature should not exceed 30 degrees. Keep drops in the refrigerator is prohibited. After purchase, they must be used within 2 years. If the bottle has already been opened, then use the medicinal solution within 30 days.

The main component of the drug is an antibiotic that has a wide range of effects. It belongs to the minoglycosides. In low concentrations, it has a bacteriostatic effect, disrupts the process of protein production. At high concentrations, it has a bactericidal effect, since the death of pathogenic cells is observed.

The presented medication is active against:

• golden staphylococcus aureus;
• Pseudomonas aeruginosa;
• Klebsiella pneumonia;
• coli;
• mirabilis prosthesis.

When applied topically, the active ingredient of the drug is absorbed in low concentrations.

The active compound, tobramycin, is poorly absorbed through the cornea. If you exceed the frequency of use of the drug solution, this can lead to an increase in the concentration of the main component in the intraocular fluid.

Antibacterial drops can be prescribed in the presence of the following pathological changes:

• blepharitis;
• blepharoconjunctivitis;
• dacryocystitis and meibomite;
• conjunctivitis, keratoconjunctivitis;
• keratitis;
• iridocyclitis.

The drug solution must be dripped into the conjunctival sac. For the drug to have the maximum effect, you should adhere to the following plan:

1. Wash hands thoroughly with soap.
2. Hold the bottle with the drug for 2 minutes in the palms and shake to form an equilibrium suspension.
3. Lie on the sofa, tilt your head back and pull the lower eyelid.
4. Introduce the required number of drops into the conjunctival sac.
5. Close your eyes and press on the inner corner with your finger.
6. When using drops, make sure that the tip of the bottle does not touch the mucous membranes and eyelashes.
7. Close the bottle after use.

On the video - how to apply drops for adults:

The duration of the therapeutic course can be determined by the attending physician based on the diagnosis and course of the pathology.

Use Tobradex drops for adults 1-2 drops in the affected organ of vision with an interval of 4-6 hours. Tobradex eye drops should not be used in children under 1 year of age. Older patients are prescribed the medicine 1 drop in each eye 3 times a day.

You can buy Tobradex drops at any pharmacy without a doctor's prescription. Their cost is 201 rubles. But why there may be a burning sensation when instilled, this information will help to understand.

When it is not possible to use Tobradex for the treatment of eye diseases (allergy, lack of the drug in pharmacies), the doctor prescribes such analogues:

1. Brulamycin. It is an antibacterial drug with a wide range of effects. It has a bactericidal effect. You can buy it at a price of 126 rubles. It is also worth using Okopin eye drops.
2. Bramitob. An antibacterial drug with a wide spectrum of influence, belonging to the group of aminoglycosides. The cost is 108 rubles. It will also be useful to learn about what the instructions for using Ookuflash eye drops are.

   Bramitob

3. dilaterol. It has the same active ingredient as Tobradex. Effective against many pathogenic microorganisms. It can be used to treat eye diseases in children and adults. You can buy the drug in a pharmacy at a price of 180 rubles. But what is the instruction for using Dancil eye drops and which ones should be used, indicated here.

   dilaterol

4. Eye drops Tobropt. Tobramycin is the main ingredient. A broad-spectrum antibiotic belonging to the group of aminoglycosides. Not to be used by children, pregnant women and women while breastfeeding. The price of the medicine is 129 rubles.
5. Tobracin. A powerful antibiotic that helps reduce unpleasant symptoms after the first use. The cost of the medicine is 134 rubles. It will also be useful to learn more about how Emoxy Optic eye drops look and how they are used.
6. Nebtsin. Another antibacterial drug that is approved for use in children, but pregnant and breastfeeding women should refuse such treatment. You can buy medicine at a price of 145 rubles. It is also worth paying more attention to how Hilokomod eye drops look and how they are used.
7. Tobrin. The drug is prescribed in the treatment of inflammatory diseases of the organs of vision of bacterial origin. Its cost is 331 rubles. It is worth learning more about how and where Alkain eye drops are most often used.

Tobradex is an effective antibacterial drug presented in the form of eye drops. It is effective against many bacteria. The therapeutic effect is observed already on the 2nd day after use. If after 5 days there is no positive dynamics, then stop treatment with this drug.

Ocular lesions of an infectious nature, most often, require the use of antimicrobials from the group of antibacterial agents. In order to provide a therapeutic effect in the shortest possible time and achieve a reduction in symptoms, broad-spectrum antibiotics are used, one of the most prominent representatives of which are Tobramycin eye drops.

The drug is available in the form of a clear solution, packaged in 5 ml plastic bottles, each of which has a built-in dropper and is placed in a package with an enclosed official instruction.

The main active ingredient is tobramycin, an antimicrobial agent with a wide spectrum of action and part of the aminoglycoside group. 1 ml of solution contains 3 mg of the active substance, not counting the auxiliary components.

To store the drug, the following conditions are necessary: ​​the temperature regime of the refrigerator, inaccessibility to children and direct sunlight. Subject to the required conditions, the drug retains its properties for 3 years, and after opening, the use of the drug is recommended for no longer than 1 month.

Eye drops belong to the group of drugs with antimicrobial action. Their therapeutic effect is due to the properties of the main active ingredient - tobramycin, a broad-spectrum antibiotic from a number of aminoglycosides.

Tobramycin in small quantities has a bacteriostatic effect: it affects the development and growth of bacteria, suppressing them. If the infection develops at a high rate, then the dose of the drug is increased. In this case, the action of the drug is classified as bactericidal - the destruction of pathogenic microflora by disrupting the function of the cytoplasmic membrane in cells.

The action of tobramycin extends to most gram-positive and gram-negative bacteria. The strength of the effect of the active substance in relation to some of them exceeds the therapeutic effect of gentamicin and neomycin. However, in relation to the vast majority of strains of group D streptococci, the antibiotic is not active.

When applied topically, extremely low systemic absorption was noted.

The drug is prescribed for inflammatory processes of an infectious nature, if the disease is caused by microorganisms sensitive to the active substance. Most often, such conditions occur with the development of the following diseases:

• Conjunctivitis- the development of the inflammatory process in the conjunctiva. In most cases, bacterial conjunctivitis is caused by some of the most common pathogenic bacteria. The main symptom of bacterial conjunctivitis is dilated blood vessels and the presence of pus in the lacrimal fluid;
• Blepharitis- inflammation of the edges of the eyelids, most often of an infectious nature. Even if the infectious agent is not of bacterial origin, then in the process of pathology development it is possible to attach a bacterial infection. Therefore, in most cases, the antibiotic is used in the treatment of all types of diseases: simple, seborrheic, ulcerative, demodicosis;
• Keratitis- an inflammatory lesion of the cornea, which has a different etiology and is expressed by clouding of the cornea, decreased visual acuity, pain. Keratitis are relatively rare, but are characterized by more severe consequences, up to loss of vision.

The use of Tobramycin is also effective in mixed types of infections: blepharoconjunctivitis, keratoconjunctivitis, etc. The drug is actively used for preventive and therapeutic purposes in the fight against inflammation in the postoperative and post-traumatic periods.

The main contraindication when using the drug is intolerance to antibiotics from the aminoglycoside group. Patients with a tendency to allergic manifestations should be careful when using drops for the first time.

Since the active substance has a slight systemic penetration, special care should be taken in patients with renal insufficiency - the remains of the substance are excreted through the kidneys. The recommendation is of particular relevance for long-term use of the drug.

In case of urgent need, the appointment of Tobramycin in ophthalmology for treatment during the gestational period is allowed. However, such use is strictly justified and takes place under the supervision of a physician. This refers to situations where the benefits of using the drug significantly outweigh the risk of possible abnormalities in the development of the fetus.

For the treatment of young children, the use of Tobramycin may also be possible only if there is a threat of serious complications in the development of infection. The medicine is prescribed by the district pediatrician, and at the initial stages, enhanced monitoring of the degree of therapeutic effect is also carried out.

Side effects can develop in the form of ordinary sensations of discomfort and characteristic manifestations of allergies.

The appearance of negative reactions may occur at the beginning of treatment, but if after several procedures they do not disappear, you should stop instillation and consult a doctor to change the drug.

Eye drops Tiotriazolin with instructions for use

This article will tell you about what scotoma is and how to treat this pathology.

Dry eye syndrome: symptoms and treatment

Prolonged use of any drug with an antibiotic can cause the development of superinfection, when the pathogen develops resistance to the active substance. And Tobramycin is no exception. Therefore, it is not recommended to use the medicine for longer than 1 month.

For a complete treatment, you should stop wearing contact lenses, and during the course of treatment you should constantly do bacteriological seeding for the pathogen (if the result of treatment is unsatisfactory).

Eye drops Tobramycin is a highly effective antibacterial drug that is active against most pathogenic bacteria, used in the treatment and prevention of infectious eye inflammations.

However, like any antibacterial agent, it requires a careful attitude and can only be used after examination by an ophthalmologist and its appointment.

Also read about what drugs are for people working as welders, and how to choose children's antibiotic drops.

chemical name

(2S,3R,4S,5S,6R)-4-amino-2-(hydroxy)-2-hydroxycyclohexyl]oxy)-6-(hydroxymethyl)oxane-3,5-diol

This substance belongs to the group aminoglycoside antibiotics wide spectrum of activity. The connection is a product of vital activity actinomycete Streptomyces tenebrarius.

Molecular weight of the substance = 467.5 grams per mole. The product is highly soluble in water, poorly - in ethyl alcohol, almost insoluble in broadcast and chloroform. In preparations, it is most often found in the form Tobramycin sulfate,molecular weight of sulfate= 1425 g per mole.

The agent is produced in the form of solutions for injections of various concentrations; sterile powder for the preparation of solutions; eye ointment 0.3%; solutions for inhalation administration.

Bactericidal, antibacterial.

When using low concentrations of the agent, it has bacteriostatic action, at high concentrations bactericidal.

The substance blocks the normal processes of synthesis ribosome subunits and disrupts the synthesis of white molecules. Further, if the concentration of the drug is high enough, the drug leads to dysfunction cytoplasmic membrane leads to the death of microbes.

Tobramycin acts on gram negative and gram-positive bacteria: Escherichia coli, Proteus (almost all strains), Klebsiella, Serratia spp., Enterobacter aerogenes, Salmonella, Shigella, Providencia spp., Citrobacter spp., Haemophilus aegyptius, Haemophilus influenzae, Moraxella lacunata, Herellea vaginacola, Neisseria gonorrhoeae and some strains Neisseria spp., Morganella morganii, Acinetobacter calcoaceticus; Enterococcus spp., Staphylococcus (most strains), Streptococcus (beta-hemolytic strains, Streptococcus pneumoniae, non-hemolytic strains).

It has also been proven that antibiotic more effective in the treatment of diseases caused by bacteria resistant to gentamicin or neomycin. The effect of the substance is more pronounced in the treatment of infections associated with Pseudomonas aeruginosa.

The tool is ineffective against various strains group D streptococcus.

Unlike intramuscular injection, when taken orally, the drug is poorly absorbed. gastrointestinal tract. The agent reaches its maximum concentration in 30 minutes - 1.5 hours.

After a single intramuscular injection at a dosage of 1 μg per kg of the patient's weight, an equilibrium concentration of 4 μg per ml of blood is reached and maintained for 8 hours. Intravenous administration provides similar concentrations.

The substance almost does not bind to plasma proteins and does not accumulate. The compound is found in sputum containing abscess, synovial fluid. The medicine does not overcome blood-brain barrier however crosses the placenta. Tobramycin is not metabolized. The substance is excreted through the kidneys, with the help of glomerular filtration. A day later, only 7% of the agent is present in the blood plasma and biological fluids. The half-life is 120 minutes.

In patients with impaired renal function and newborns pharmacokinetic parameters may differ slightly, the drug can be found in the body for a longer period of time.

When conducting dialysis, depending on the intensity and type of procedure, 25 to 70% of the drug can be removed.

When used locally as part of eye drops, the substance is not subjected to systemic absorption.

The chemical compound is part of the solutions for intramuscular and intravenous introductions:

• for the treatment of infectious diseases caused by microorganisms sensitive to the action of antibiotic(biliary tract, joints, bones, central nervous system, abdominal cavity, respiratory organs, skin, soft tissues, biliary and urinary tract);
• after surgical interventions for the prevention or treatment of various inflammatory processes;
• at sepsis.

Tobramycin for the eyes, as part of drops and gels, is used for bacterial infections of the eye: blepharitis, keratoconjunctivitis, keratitis, conjunctivitis, blepharoconjunctivitis, iridocyclitis.

Inhalations with Tobramycin are prescribed:

• for the treatment of respiratory tract infections caused by Pseudomonas aeruginosa;
• children from 6 years of age, sick cystic fibrosis.

The medicine is not prescribed:

• in case of hypersensitivity to this antibiotic or group aminoglycosides;
• patients with renal insufficiency;
• at acoustic neuritis;
• pregnant women;
• with disorders in the functioning of the brain caused by insufficient function 8 pairs of cranial nerves.

With caution, the drug is used:

• in elderly patients;
• at botulism;
• in patients with myasthenia gravis or Parkinson's disease;
• with a strong dehydration organism;
• during breastfeeding.

With systemic use, the following adverse reactions may occur:

• diarrhea, abnormal liver function, increased levels of liver enzymes, or bilirubin;
• vomiting, nausea, polyuria feeling of thirst, oliguria, proteinuria, increasing nitrogen levels in urea and creatinine frequent or infrequent urination, dizziness;
• proteinuria, disorders of tubular secretion;
• anemia,leukocytosis, thrombocytopenia, leukopenia, granulocytopenia;
• defeat vestibular apparatus and hearing, deafness, vertigo, noise in ears;
• headaches, drowsiness, convulsions, movement orientation disorders;
• paresthesia, hypocalcemia, insufficiency sodium and magnesium in blood;
• rashes and itching on the skin, hyperemia, fever, eosinophilia, angioedema, others allergic reactions.

After inhalation, the likelihood of developing:

• ulcerative lesions of the oral cavity, fungal infections;
• shortness of breath bronchospasm, nosebleeds;
• runny nose, voice changes, coughing, pharyngitis, laryngitis;
• sinusitis, hyperventilation, asthma, hypoxia.

When using the product in ophthalmic practice, local reactions appear:

• itching, swelling and redness of the eyelids;
• burning and pain during and after instillation or application of the ointment;
• blurred vision.

Depending on the dosage form, disease and age, different treatment regimens and dosages are used.

As a rule, the introduction of the drug is carried out drip, in the form infusions. Before using the solution injections bred in isotonic solution of sodium chloride or glucose. The duration of the procedure is from 20 minutes to an hour.

Before intramuscular administration, the drug is dissolved in a 0.5% solution of procaine or in water.

The dosage is different - depending on the localization of the infection and the type of pathogen.

On average, the daily dosage for an adult is calculated at 2-3 mg per kg of body weight. Injections are made 3 times a day.

For children from 2 months, dosage adjustment is necessary. As a rule, from 6 to 7.5 mg of the drug is used per kg of the child's weight. Frequency rate of introduction - as for adults.

Also, the drug is prescribed in the form inhalations. You must follow the doctor's instructions.

With an infectious process of moderate severity, 1-2 drops are instilled into the affected eye ( conjunctival sac), 3-4 times a day, every 4 hours.

If a severe infectious process has developed, then it is indicated to use eye drops every hour - 30 minutes. After reducing inflammation, they switch to the normal mode of taking the drug.

Eye ointment is applied over the affected eyelid, 2-3 times a day. According to indications, the frequency of use of the drug can be increased up to 4 times a day. Then they switch to the normal reception mode.

The duration of treatment depends on its effectiveness.

In case of overdose, renal failure develops, disorders vestibular apparatus and hearing neuromuscular blockade, respiratory paralysis.

It is important for the patient to provide ventilation and oxygenation,hydration, normal urination, the level should be monitored creatinine and antibiotic in the blood, can be carried out hemodialysis.

Furosemide and ethacrynic acid when combined with a substance, lead to an increase ototoxicity drugs.

Solution for parenteral use should not be mixed in a dropper or syringe with other medicines.

Co-administration of Tobramycin with aminoglycosides, cephalosporins and polypeptide antibiotics increased stress on the kidneys.

The drug enhances neurotoxicity vancomycin.

Tobramycin when combined with muscle relaxants, in particular tubocurarine enhances their muscle-relaxing effect.

A prescription is required.

Store the drug in accordance with the recommendations on the package, they differ depending on the dosage form.

Solution for injection and infusion is stored for 2 years.

Shelf life for eye drops and capsules for inhalation is 3 years.

Once opened, the eye drops can be stored at a low temperature for up to 1 month.

If the patient has previously had hypersensitivity reactions to the group aminoglycosides, then the likelihood of developing allergic reactions to Tobramycin is high.

Reversible or complete deafness due to drug treatment may occur after the end of treatment. During therapy with the drug, it is recommended to monitor the general condition of the patient, kidney function, calcium levels, creatinine, protein in urine, sodium and magnesium in blood plasma, conduct audiometric tests.

Sometimes special groups of patients require dosage adjustment (pregnant women, with peritonitis and burns, persons with high cardiac output or glomerular rate).

It should be remembered that prolonged use of the substance leads to the development superinfections, most often mycoses.

Between the instillation of this drug and any other drug in the form of eye drops, it is recommended to take a 5-minute break.

The use of Tobramycin in pregnant women is permissible in extreme cases, when there is a serious threat to the life of the mother.

The use of this drug in pregnant women can cause complete deafness in the fetus, the substance accumulates in the kidneys.

If there is a need to take the drug during lactation, then feeding should be stopped.

Trade names of Tobramycin: Tobrex, Bramitob, Dilaterol, Tobi, Tobrom, Brulamycin, Tobropt, Nebtsin, Tobrazon, Dilaterol, Toby Podhaler, Tobramycin-Gobbi, Tobriss, Tobrosopt.

Tobramycin INN

Description of the active substance (INN) Tobramycin.

Pharmacology : pharmachologic effect - antibacterial . Suppresses the growth and development of gram-negative and gram-positive microorganisms. Active against: Staphylococcus aureus, Citrobacter species, Enterobacter species, E.coli, Klebsiella species, Morganella morganii, Pseudomonas aeruginosa, Proteus mirabilis, Proteus vulgaris, Providencia species, Serratia species.

Poorly absorbed in the gastrointestinal tract, rapidly absorbed when administered intramuscularly. Cmax is reached in 30-90 minutes. A single intravenous or intramuscular injection provides a therapeutic concentration in the body (4-6 μg / ml) for 6-8 hours. It does not bind to plasma proteins. Penetrates into the sputum, peritoneal and synovial fluid, the contents of the abscess. Passes through the placenta. Excreted by the kidneys unchanged (93% per day). T1 / 2 - 2 hours. Dialysis removes 25-70%.

Indications : Severe bacterial infections: septicemia in newborns, children and adults, infections of the lower respiratory tract, incl. with cystic fibrosis, pleural empyema, meningitis; abdominal infections, incl. peritonitis, skin and bone infections, complicated and recurrent urinary tract infections.

Eye drops - external infections of the eye and its appendages.

Contraindications : Hypersensitivity, incl. to other aminoglycosides, myasthenia gravis, parkinsonism, chronic renal failure, dysfunction of the VIII pair of cranial nerves, dehydration, pregnancy, old age.

Side effects : Irreversible damage to the vestibular and auditory branches of the VIII pair of cranial nerves with partial or complete bilateral deafness, dizziness, vertigo, tinnitus, headache, disorientation, drowsiness, paresthesia, muscle fasciculations, convulsions, impaired renal function (oliguria, cylindruria, proteinuria, tubular disorders, increased creatinine and urea nitrogen), anemia, leukopenia, granulocytopenia, thrombocytopenia, leukocytosis, eosinophilia, nausea, diarrhea, increased activity of transaminases and LDH, bilirubin levels, hypocalcemia, hyponatremia, hypomagnesemia, fever, rash, pruritus , anaphylaxis. With conjunctival use - local allergic reactions in the form of itching, swelling of the eyelids.

Interaction : Increases neuro- and nephrotoxicity of other drugs. The likelihood of side effects increases against the background of loop diuretics (furosemide, ethacrynic acid). Decamethonium, tubocurarine, succinylcholine increase the risk of neuromuscular blockade.

Overdose : Manifested by impaired renal function, acute renal failure, auditory and vestibular disorders, neuromuscular blockade, paralysis of the respiratory muscles.

Treatment: ensuring adequate ventilation and oxygenation, hydration (urine excretion of at least 3-5 ml / kg / h) under the control of fluid balance, Cl creatinine, plasma tobramycin levels; performing hemodialysis.

Dosage and administration : In / m, in / in, conjunctival. For adults, a saturating dose is 1.5-2.0 mg / kg, maintenance - from 3 mg / kg / day in three doses (every 8 hours) to 5 mg / kg / day after 6 hours. Children - 6.0- 7.5 mg / kg / day in 3-4 doses, premature babies and newborns - up to 4 mg / kg / day in two doses. The usual course duration is 7-10 days. For intravenous infusion, it is diluted in 50-100 ml of isotonic sodium chloride solution or 5% glucose solution, injected drip for 20-60 minutes. Eye drops - conjunctival, 1 drop in the eye, 5 times a day, with acute infections, you can - after 30 minutes - 1 hour.

Precautionary measures : Patients should be under strict medical supervision due to the high potential risk of neurotoxic and nephrotoxic effects, and regular audiometric testing is recommended. It should be borne in mind that in some patients, irreversible partial or complete deafness may form after the end of treatment. With an increase in the volume of distribution of the drug (pregnancy, burns, peritonitis, infection of the retroperitoneal space), the dose should be increased to achieve an effective concentration, and in critical conditions and in young patients with high cardiac output and glomerular filtration rate, the frequency of administration should be increased. Elderly patients and patients with renal insufficiency need to reduce the dose or increase the intervals between injections. Regular determination of the level of creatinine, urea nitrogen, calcium, sodium, magnesium in plasma, relative density of urine, protein in urine, urinary sediment is shown. Prolonged topical use can lead to superinfection, incl. fungal. Breastfeeding mothers are advised to stop breastfeeding.

Structural formula

Russian name

Latin name of the substance Tobramycin

chemical name

O-3-Amino-3-deoxy-alpha-D-glucopyranosyl-(1"6)-O--2-deoxy-D-streptamine (and as sulfate)

Gross formula

Pharmacological group of the substance Tobramycin

Nosological classification (ICD-10)

CAS code

Characteristics of the substance Tobramycin

Aminoglycoside antibiotic. Produced by actinomycete Streptomyces tenebrarius. Tobramycin is easily soluble in water (1:1.5), very slightly soluble in ethanol (1:2000), practically insoluble in chloroform and ether; molecular weight 467.52. Tobramycin sulfate: molecular weight 1425.45.

Pharmacology

Blocks the 30S subunit of ribosomes and inhibits protein synthesis. At higher concentrations, it disrupts the function of cytoplasmic membranes, causing cell death. Suppresses the growth and development of gram-negative and gram-positive microorganisms. Most active in relation to Staphylococcus spp., including Staphylococcus aureus and Staphylococcus epidermidis(coagulase-negative and coagulase-positive), incl. penicillin-resistant strains Citrobacter spp., some types Streptococcus spp.(including beta-hemolytic strains from group A, some non-hemolytic strains, Streptococcus pneumoniae), Pseudomonas aeruginosa, Escherichia coli, Klebsiella pneumoniae, Enterobacter aerogenes, Morganella morganii, Proteus mirabilis, most strains Proteus vulgaris, Haemophilus influenzae, Haemophilus aegyptius, Moraxella lacunata, Acinetobacter calcoaceticus, some types Neisseria. Bacterial susceptibility tests show that, in some cases, organisms resistant to gentamicin remain sensitive to tobramycin.

Poorly absorbed from the gastrointestinal tract. Rapidly absorbed with intramuscular injection, C max is reached in 30-90 minutes. A single intramuscular injection at a dose of 1 μg/kg provides a serum concentration of 4 μg/ml for 8 hours. With an intravenous infusion for 1 hour, the serum concentration is similar to that with an intramuscular injection. Therapeutic serum concentration, as a rule, makes 4-6 mcg/ml. Practically does not bind to plasma proteins. In patients with normal renal function other than neonates, tobramycin sulfate administered every 8 hours does not accumulate in serum. In patients with reduced renal function and neonates, serum antibiotic concentrations are usually higher and may be determined over a longer period of time. Penetrates into the sputum, peritoneal and synovial fluid, the contents of the abscess. Practically does not penetrate through the intact BBB. Passes through the placenta. Excreted by the kidneys unchanged by glomerular filtration, in patients with normal renal function, 84% of the dose is excreted within 8 hours, 93% - within 24 hours. 75-100 mcg/ml. In case of impaired renal function, the excretion of tobramycin sulfate slows down and the accumulation of the substance can create a toxic level in the serum. T1 / 2 from serum - 2 hours. Dialysis removes 25-70% (depending on the duration and type of dialysis).

When inhaled, tobramycin predominantly remains in the respiratory tract, bioavailability depends on the technique of inhalation and the condition of the respiratory tract. 10 minutes after inhalation at a dose of 300 mg, the average concentration of tobramycin in sputum is 1237 mcg / g (35-7414 mcg / g). Tobramycin does not accumulate in sputum, the concentration varies widely. After 2 hours after inhalation, the concentration of tobramycin is 14% of the concentration after 10 minutes. The average serum concentration of tobramycin 1 hour after inhalation at a dose of 300 mg in patients with cystic fibrosis is 0.95 μg / ml, 20 weeks after the start of treatment - 1.05 μg / ml. It is excreted mainly with sputum, a small part - by glomerular filtration.

When applied topically in ophthalmology, systemic absorption is negligible.

The use of the substance Tobramycin

For i / m and / in the application: infectious diseases caused by sensitive microflora - infections of the biliary tract, bones and joints (including osteomyelitis), central nervous system (including meningitis), infections of the abdominal cavity (including peritonitis), respiratory organs (including .h pneumonia, pleural empyema, lung abscess), infections of the skin and soft tissues (including infected burns), urinary tract (including pyelonephritis, pyelitis, cystitis), sepsis, postoperative infections.

For inhalation use: respiratory tract infections caused Pseudomonas aeruginosa(Pseudomonas aeruginosa) in patients with cystic fibrosis aged 6 years and older.

In ophthalmology: bacterial infections of the eye and its appendages caused by sensitive microflora, incl. blepharitis, conjunctivitis, keratoconjunctivitis, blepharoconjunctivitis, keratitis, iridocyclitis.

Contraindications

Hypersensitivity, incl. to other aminoglycosides; severe chronic renal failure, impaired function of the VIII pair of cranial nerves, neuritis of the auditory nerve.

Application restrictions

Renal failure, botulism, myasthenia gravis, parkinsonism, dehydration, old age; hemoptysis (for inhalation use).

Use during pregnancy and lactation

If the use of tobramycin is required for life-threatening conditions or for the treatment of serious illness in pregnant women in the event of failure of other drugs, it is necessary to compare the benefit to the mother and the potential risk to the fetus, because. tobramycin causes complete irreversible bilateral congenital deafness and accumulates in the kidneys of the fetus.

If it is necessary to use tobramycin during lactation, breastfeeding should be discontinued (due to the possibility of ototoxicity and nephrotoxicity in the newborn).

Side effects of Tobramycin

System effects

From the digestive tract: nausea, vomiting, diarrhea, liver dysfunction (increased activity of hepatic transaminases, LDH, bilirubin levels).

From the side of the cardiovascular system and blood (hematopoiesis, hemostasis): anemia, leukopenia, leukocytosis, granulocytopenia, thrombocytopenia.

From the nervous system and sensory organs: ototoxicity - irreversible damage to the vestibular and auditory branches of the VIII pair of cranial nerves with partial or complete bilateral deafness, dizziness, vertigo, tinnitus; headache, disorientation, drowsiness, paresthesia, muscle fasciculations, convulsions.

From the genitourinary system: nephrotoxicity (oliguria, cylindruria, proteinuria, tubular disorders, increased levels of creatinine and urea nitrogen, a significant increase or decrease in the frequency of urination, polyuria, thirst).

Allergic reactions: pruritus, skin hyperemia, rash, fever, angioedema, eosinophilia.

Others: hypocalcemia, hyponatremia, hypomagnesemia.

When inhaled

From the respiratory system: voice change, shortness of breath, increased cough, laryngitis, pharyngitis, bronchospasm, worsening lung function, increased sputum, hemoptysis, epistaxis, rhinitis, sinusitis, asthma, hypoxia, hyperventilation.

Local reactions: ulcers and oral candidiasis.

When used in ophthalmology: local allergic reactions in the form of itching, redness, swelling of the eyelids; burning sensation or burning pain; for ophthalmic ointment only (optional) - Blurred vision.

Interaction

Increases neuro-, oto- and nephrotoxicity of other drugs. The probability of manifestation of ototoxicity increases against the background of loop diuretics (furosemide, ethacrynic acid). Enhances the action of non-depolarizing muscle relaxants. Reduces the effect of antimyasthenic drugs. In / in the introduction of indomethacin reduces the renal clearance of tobramycin, increasing the concentration in the blood and increasing T 1/2 (dosage adjustment may be required). Methoxyflurane increases the risk of side effects. Drugs for inhalation general anesthesia (halogenated hydrocarbons), narcotic analgesics, transfusion of large amounts of blood with citrate preservatives as anticoagulants, drugs that block neuromuscular transmission increase neuromuscular blockade. In the case of simultaneous administration of topically tobramycin and aminoglycoside antibiotics systemically, it is possible to increase the side effects of a systemic nature.

Overdose

Symptoms: impaired renal function, acute renal failure, auditory and vestibular disorders, neuromuscular blockade, paralysis of the respiratory muscles; in ophthalmology - severe lacrimation, itching, redness or swelling of the eyes or eyelids, punctate keratitis.

Treatment: ensuring adequate ventilation and oxygenation, hydration (urine excretion of at least 3-5 ml / kg / h) under the control of fluid balance, creatinine clearance, plasma tobramycin levels (it is necessary to carefully monitor plasma concentrations until a level of less than 2 μg / ml is reached); hemodialysis (in patients with T 1/2 more than 2 hours or impaired renal function). The specific antidote is unknown.

Routes of administration

In / m, in / in, inhalation, conjunctival.

Substance Precautions Tobramycin

Patients with hypersensitivity to other aminoglycosides may be hypersensitive to tobramycin.

Patients should be under strict medical supervision due to the high potential risk of neurotoxic and nephrotoxic effects, it is recommended that audiometric tests be performed regularly. It should be borne in mind that in some patients, irreversible partial or complete deafness may form after the end of treatment. With an increase in the volume of distribution of the drug (pregnancy, burns, peritonitis, infection of the retroperitoneal space), the dose should be increased to achieve an effective concentration, and in critical conditions and in young patients with high cardiac output and glomerular filtration rate, the frequency of administration should be increased. Elderly patients and patients with renal insufficiency need to reduce the dose or increase the intervals between injections. Regular determination of the level of creatinine, urea nitrogen, calcium, sodium, magnesium in plasma, relative density of urine, protein in urine, urinary sediment is shown.

Tobramycin eye drops are an antibacterial medication from the aminoglycoside group. The drug effectively fights gram-positive and gram-negative bacteria and is successfully used to treat conjunctivitis and other eye pathologies. Before you start using the drug, you need to consult an ophthalmologist.

Composition, form of release and mechanism of work

The active component of "Tobramycin" is an antibiotic - tobramycin. In 1 ml of its solution contains 3 mg. Additional components are sodium chloride and benzalkonium, hypromellose, hydrochloric acid and purified water. Pharmacy chains receive medication in plastic bottles. There is a dropper at the end of the package. "Tobramycin" has an antimicrobial effect by suppressing the growth of pathogenic microorganisms. The drug is effective against almost all gram-positive and gram-negative bacteria.

When used externally, the pharmaceutical preparation is practically not absorbed into the systemic circulation.

"Tobramycin": the main indications for use

The drug is used in the treatment of diseases that are accompanied by inflammation of the eyelids.

The instruction for the use of eye drops acquaints the user with the fact that Tobramycin is used to treat the following eye pathologies:

• blepharoconjunctivitis;
• conjunctivitis;
• keratoconjunctivitis;
• blepharitis;
• inflammation of the cornea and iris of the eye.

Instructions for use

Eye drops "Tobramycin" should be instilled into the conjunctival sac. The correct dosage and duration of use of the drug is determined by the attending ophthalmologist. However, mostly adult patients are prescribed 2 drops of "Tobramycin" in each organ of vision. An interval of 4 hours must be observed between instillations. To achieve the maximum effect from the use of the drug, a person needs to complete the following algorithm of actions:

1. Wash your hands well.
2. Shake the medicine bottle.
3. Tilt your head back.
4. Pull the lower eyelid with your finger.
5. Drop the visual organ with the required amount of medication.
6. Close your eyes and press your finger on the inner corner.

When is the medicine not used?

The medication has a number of contraindications for use, one of which is hearing loss.

Eye drops called "Tobramycin" are not prescribed in the following situations:

• hearing impairment;
• kidney failure;
• individual intolerance to individual components that are part of the drug;
• botulism;
• violation of water and electrolyte balance.

Adverse reactions

Sometimes Tobramycin eye drops can cause the following side effects:

• loss of appetite;
• gagging;
• weakness;
• vertigo;
• dyspnea;
• inflammation of the mucous membrane and lymphoid tissue of the pharynx;
• bronchospasm;
• inflammation of the mucosa of the paranasal sinuses;
• pain in the ears;
• increase in body temperature;
• asthenic syndrome;
• pain in the head;
• allergy.

Overdose

In case of an overdose of the drug, respiratory paralysis may occur and artificial ventilation of the lungs may be required.

If the patient has exceeded the prescribed dose of eye drops, he may experience kidney failure, malfunctions in the normal functioning of the vestibular apparatus, as well as respiratory paralysis. In such a situation, treatment is carried out aimed at stopping the symptoms that have arisen. Artificial ventilation may be required. Sometimes they resort to the help of extrarenal blood purification. It is important to control plasma creatinine levels.

drug interaction

The simultaneous use of eye drops "Tobramycin" with antibiotics of the polypeptide group, aminoglycosides and cephalosporins increases the load on the kidneys. The use together with "Vancomycin" enhances its neurotoxicity. It is not recommended to use such a medication with muscle relaxants, since Tobramycin enhances muscle relaxation.