Tobramycin

Tobramycin is a aminoglycoside antibiotic medicine available in Bangladesh under many brand names. Below are its uses, dosage, side effects and precautions — and all brands with their current prices.

• Treatment of external bacterial infections of the eye and its adnexa, such as bacterial conjunctivitis, blepharitis, and keratitis, caused by susceptible organisms.
• Inhaled respiratory solution: management of chronic lung infection due to Pseudomonas aeruginosa in appropriate patients with cystic fibrosis, as prescribed by a specialist.
• It is not useful for viral or fungal eye infections unless a bacterial infection is also being treated under medical supervision.

Use exactly as prescribed, because dosing depends on the infection site, severity, product strength, age, kidney function, and the dosage form. For eye drops, adults are commonly instructed to instill 1–2 drops into the affected eye at regular intervals; more frequent dosing may be used initially for severe infections under medical advice. Eye ointment is usually applied as a small ribbon inside the lower eyelid at prescribed intervals. For inhaled respiratory solution in cystic fibrosis, the commonly used regimen is nebulised dosing in repeated treatment cycles, but the exact dose and cycle must be set by the specialist. Do not stop early or change the dose without the prescriber’s advice.

• Eye preparations: temporary burning, stinging, irritation, itching, redness, eyelid swelling, tearing, or blurred vision after application.
• Eye preparations: allergic reaction or worsening eye inflammation; seek medical help if severe pain, swelling, rash, or vision changes occur.
• Inhaled solution: cough, throat irritation, voice change, wheezing, shortness of breath, chest tightness, or altered taste.
• Serious but less common risks, especially with significant systemic exposure or combined aminoglycoside therapy: hearing loss, ringing in the ears, dizziness or balance problems, kidney problems, and neuromuscular weakness or breathing difficulty.

Tell the doctor if there is allergy to tobramycin or other aminoglycosides, kidney disease, hearing or balance problems, myasthenia gravis, Parkinson’s disease, breathing problems, or if other antibiotic, kidney-affecting, or hearing-affecting medicines are being used. Avoid touching the eye dropper or ointment tip to the eye or any surface, and do not wear contact lenses during an active eye infection unless advised. Inhaled solution should be used with the recommended nebuliser system and stopped only if the doctor advises. Use under a registered doctor's or pharmacist's guidance.

• Other aminoglycosides or medicines that may damage the kidneys or hearing can increase toxicity risk, especially if tobramycin is absorbed systemically.
• Loop diuretics such as furosemide or ethacrynic acid may increase the risk of hearing-related toxicity when combined with aminoglycosides.
• Neuromuscular blocking medicines, anaesthetics, or conditions causing muscle weakness may increase the risk of breathing difficulty.
• If using more than one eye medicine, separate applications by several minutes; apply eye ointment last unless advised otherwise.
• No important food interaction is expected with eye or inhaled forms.

• Known hypersensitivity to tobramycin.
• Known hypersensitivity to other aminoglycoside antibiotics or to any component of the product.
• Use in non-bacterial eye conditions without medical supervision is inappropriate and may delay correct treatment.

During pregnancy or breastfeeding, tobramycin should be used only when the expected benefit justifies the potential risk and after medical advice. Eye preparations usually have low systemic absorption, and inhaled preparations have lower systemic exposure than injections, but aminoglycosides as a class can be associated with fetal or infant safety concerns when systemic exposure is significant. Breastfeeding mothers should seek advice and monitor the baby for unusual symptoms such as diarrhoea, rash, or thrush.

Store according to the product label, away from excessive heat, moisture, and direct light, and keep out of reach of children. Keep eye drops and ointment tightly closed and avoid contaminating the tip; discard after the recommended in-use period. Respiratory solution ampoules are commonly stored refrigerated and protected from light, unless the label allows limited room-temperature storage; do not use if the solution is discoloured, expired, or the container is damaged.