Tobramicina
Tobramycin
Tobramycin sulfate
También conocido como: TOBI · Brulamycin · Gernebcin · Mytobrin · Tobrex · tobramycin sulphate · Tobramycinum
Revisado por el equipo veterinario de VetSheetActualizado 5 abr 2026Referencia veterinaria basada en la evidencia
Las dosis son una referencia clínica para profesionales veterinarios autorizados. Confirme siempre con el prospecto actual y cada paciente individual.
Dosis por especie
🌎 NA — North America🌍 EU — Europe
Perros
| Indicación | Dosis | Vía | Frecuencia | Duración | Región |
|---|---|---|---|---|---|
| General susceptible infections | 2 mg/kg | IV, IM, SC | q8h | — | 🌎 NA |
| Susceptible UTI | 1-2 mg/kg | SC | q8h | — | 🌎 NA |
| Sepsis | 2-4 mg/kg | IV | q8h | — | 🌎 NA |
| Soft tissue, systemic infections | 1-1.7 mg/kg IV q8h or 3-5.1 mg/kg IV q24h | IV | q8h or q24h | < 7 days | 🌎 NA |
| Systemic infections | 2 mg/kg SC q8-12h or 4-6 mg/kg SC q24h | SC | q8-12h or q24h | < 7 days | 🌎 NA |
| Persistent bacteremia | 3-5 mg/kg IV, IM, SC q8h or 9-15 mg/kg IV, IM or SC q24h | IV, IM, SC | q8h or q24h | <= 7 days | 🌎 NA |
| Gram-negative infections | 4-6 mg/kg | IV/IM/SC | q24h | Assess according to clinical response | 🌍 EU |
- General susceptible infections: Avoid use or reduce dosage in patients with renal failure; recommend therapeutic drug monitoring, particularly in young animals. Consider consolidating to once-daily dosing (e.g., 6 mg/kg q24h).
- Gram-negative infections: For severe infections (including sepsis), doses as high as 12 mg/kg/day have been advocated, but should be used with caution given potential adverse effects.
Gatos
| Indicación | Dosis | Vía | Frecuencia | Duración | Región |
|---|---|---|---|---|---|
| General susceptible infections | 2 mg/kg | IV, IM, SC | q8h | — | 🌎 NA |
| Susceptible UTI | 1-2 mg/kg | SC | q8h | — | 🌎 NA |
| Sepsis | 2-4 mg/kg | IV | q8h | — | 🌎 NA |
| Soft tissue, systemic infections | 2 mg/kg IV, IM or SC q12h or 4 mg/kg IV, IM, SC q24h | IV, IM, SC | q12h or q24h | <= 5 days | 🌎 NA |
| Persistent bacteremia | 2 mg/kg IV, IM, SC q8h or 6 mg/kg IV, IM or SC q24h | IV, IM, SC | q8h or q24h | <= 5 days | 🌎 NA |
| Gram-negative infections | 4-6 mg/kg | IV/IM/SC | q24h | Assess according to clinical response | 🌍 EU |
- General susceptible infections: Consider consolidating to once-daily dosing.
- Gram-negative infections: Cats may be more sensitive to toxicity. For severe infections (including sepsis), doses as high as 12 mg/kg/day have been advocated, but should be used with caution.
Pequeños mamíferos
| Indicación | Dosis | Vía | Frecuencia | Duración | Región |
|---|---|---|---|---|---|
| Susceptible infections (Llamas) | 4 mg/kg IV q24h; 0.75 mg/kg IV q8h | IV | q8h or q24h | — | 🌎 NA |
- Susceptible infections (Llamas): Dosing specifically for Llamas.
Aves
| Indicación | Dosis | Vía | Frecuencia | Duración | Región |
|---|---|---|---|---|---|
| Susceptible infections | 5 mg/kg | IM | q12h | — | 🌎 NA |
| Susceptible infections | 2.5-5 mg/kg/day | Parenteral | Daily | — | 🌎 NA |
Reptiles
| Indicación | Dosis | Vía | Frecuencia | Duración | Región |
|---|---|---|---|---|---|
| Susceptible infections | 2.5 mg/kg | IM | q24h | — | 🌎 NA |
Caballos
| Indicación | Dosis | Vía | Frecuencia | Duración | Región |
|---|---|---|---|---|---|
| Susceptible infections | 4 mg/kg | IV | q24h | — | 🌎 NA |
- Susceptible infections: Allows achievement of Cmax/MIC ratio higher than 10 for pathogen strains with a MIC of 1 microgram/mL.
Las dosis son una referencia clínica para profesionales veterinarios autorizados. Confirme siempre con el prospecto actual y cada paciente individual.
Resumen
La tobramicina es un potente antibiótico aminoglucósido parenteral utilizado principalmente por su excelente eficacia contra infecciones bacterianas aeróbicas gramnegativas graves.
Características clínicas clave:
- Espectro de actividad: Altamente eficaz contra bacilos gramnegativos aeróbicos (p. ej., Pseudomonas aeruginosa, E. coli, Klebsiella, Proteus) y algunas bacterias grampositivas aeróbicas (p. ej., Staphylococcus). Es inactivo contra anaerobios y hongos.
- Utilidad clínica: Debido a su perfil de toxicidad inherente, el uso sistémico suele reservarse para infecciones graves que ponen en peligro la vida, donde otros antimicrobianos menos tóxicos son ineficaces, o cuando se tratan cepas conocidas resistentes a la gentamicina.
- Perfil de toxicidad: Como todos los aminoglucósidos, conlleva riesgos significativos de nefrotoxicidad y ototoxicidad. Alguna evidencia de laboratorio sugiere que puede ser ligeramente menos nefrotóxica que la gentamicina, aunque esto sigue siendo objeto de debate clínico.
Perla clínica: Los aminoglucósidos exhiben una actividad bactericida dependiente de la concentración y un efecto post-antibiótico (EPA) significativo. Este perfil farmacocinético/farmacodinámico respalda firmemente la práctica moderna de dosificación de dosis altas con intervalos extendidos (una vez al día). Este enfoque maximiza la relación $C_{max}$/MIC para la eliminación bacteriana, al tiempo que proporciona un intervalo libre de fármaco que permite a las células tubulares renales eliminar el medicamento, minimizando así la nefrotoxicidad.
Mecanismo de acción
Tobramycin is a bactericidal antibiotic that disrupts bacterial protein synthesis.
- Cellular Entry: The drug enters the bacterial cell via an oxygen-dependent active transport mechanism.
Note: Because this transport requires oxygen, aminoglycosides are completely ineffective against obligate anaerobic bacteria and have reduced efficacy in anaerobic environments (e.g., abscesses, necrotic tissue).
- Target Binding: Once inside, tobramycin irreversibly binds to the 30S ribosomal subunit.
- Mechanism: Binding → misreading of mRNA → incorporation of incorrect amino acids into the growing peptide chain → production of non-functional or toxic proteins → bacterial cell death.
- Environmental Factors: Antimicrobial activity is significantly enhanced in an alkaline environment and diminished in acidic, purulent conditions.
Seguridad y advertencias
Contraindicaciones
- Known hypersensitivity to aminoglycosides
- Rabbits and hares (causes fatal disruption of GI flora)
- Pre-existing severe renal disease (unless benefits outweigh risks)
- Dehydration
- Corneal ulceration (specifically for ophthalmic preparations)
Efectos adversos
- Nephrotoxicity (acute tubular necrosis)
- Ototoxicity (vestibular and auditory damage, potentially irreversible)
- Facial edema
- Pain or inflammation at the injection site
- Peripheral neuropathy
- Hypersensitivity reactions
- Rarely: GI signs, hematologic, and hepatic effects
- Neuromuscular blockade (rare)
Precauciones
Extreme Caution Required:
- Renal Impairment: Use with extreme caution in patients with preexisting renal disease. Dosage intervals must be extended, and therapeutic drug monitoring is highly recommended.
- Risk Factors: Neonatal and geriatric patients, fever, sepsis, and dehydration significantly increase the risk of toxicity.
- Working Dogs: Use cautiously in working dogs (e.g., seeing-eye, herding, hearing-assistance dogs) due to the risk of irreversible ototoxicity (deafness or vestibular dysfunction).
- Neuromuscular Disorders: Avoid or use with extreme caution in patients with myasthenia gravis or other neuromuscular disorders due to the drug's neuromuscular blocking activity.
- Feline Sensitivity: Cats appear to be particularly sensitive to the vestibular toxic effects of aminoglycosides.
Interacciones farmacológicas
Synergistic antibacterial effects in vivo; however, can cause physical inactivation of aminoglycosides if mixed in the same syringe or IV line, or in vivo in patients with severe renal failure.
Potential for additive nephrotoxicity (historically documented with older generation cephalosporins like cephalothin).
Increased risk of nephrotoxicity and ototoxicity.
Increased risk of nephrotoxicity and ototoxicity.
Significantly increased risk of acute kidney injury.
Concomitant use can potentiate and prolong neuromuscular blockade, potentially leading to respiratory paralysis.
Increased risk of nephrotoxicity
Increased risk of ototoxicity and nephrotoxicity
In vitro chemical inactivation if mixed
Enhanced non-depolarizing neuromuscular blockade
Monitorización
- Clinical efficacy (resolution of fever, improved clinical signs, negative follow-up cultures)
- Renal toxicity: Baseline and serial urinalysis (monitoring for tubular casts, which are often the first sign of impending toxicity), urine specific gravity, serum creatinine, and BUN
- Gross monitoring for vestibular toxicity (head tilt, nystagmus, ataxia) or auditory toxicity (deafness)
- Therapeutic drug monitoring (peak and trough serum levels) is highly recommended to ensure efficacy and prevent toxicity
- Urinalysis (daily, looking for cellular casts as an early warning)
- Serum creatinine and BUN (baseline and periodically)
- Hydration status and urine output
- Auditory and vestibular function
Farmacocinética
Vida media
Absorción
Not appreciably absorbed after oral or intrauterine administration. Absorbed from topical administration during surgical irrigations. Bioavailability from extravascular injection (IM or SC) is >90%. SC injection results in slightly delayed peak levels compared to IM.
Distribución
Distributed primarily in the extracellular fluid. Found in ascitic, pleural, pericardial, peritoneal, synovial, and abscess fluids. High levels in sputum, bronchial secretions, and bile. Minimally protein bound (<20%). Does not readily cross the blood-brain barrier or penetrate ocular tissue. Crosses the placenta (fetal concentrations 15-50% of maternal serum). Accumulates in inner ear and kidneys. Volume of distribution (horses): 0.24-0.55 L/kg.
Metabolismo
Aminoglycosides are not significantly metabolized.
Eliminación
Eliminated almost entirely by glomerular filtration. Clearance (horses): 101-130 mL/kg/hr. Patients with decreased renal function can have significantly prolonged half-lives.
Sobredosis
In the event of an inadvertent overdose, rapid intervention is required to prevent permanent renal and otic damage:
- Hemodialysis: Highly effective in reducing serum levels of the drug, though rarely available in veterinary practice.
- Peritoneal Dialysis: Can reduce serum levels but is significantly less efficacious than hemodialysis.
- Drug Complexation: Intravenous administration of carbenicillin or ticarcillin (12-20 grams/day in humans) can complex with tobramycin in the blood, inactivating it. This is reportedly nearly as effective as hemodialysis.
Productos disponibles
Formulaciones
- Injection solution
- Powder for injection
- Inhalation solution
- Ophthalmic preparations
- Injectable: 40 mg/ml solution
Veterinario
- Tobramycin 40 mg/ml injectable solution
Etiquetado para humanos
- Tobramycin Sulfate Injection: 0.8 mg/mL and 1.2 mg/mL in single-dose containers
- Tobramycin Sulfate Solution for Injection: 10 mg/mL and 40 mg/mL
- Tobramycin Sulfate Powder for Injection: 1.2 grams (40 mg/mL after reconstitution)
- Tobramycin Solution for inhalation: 60 mg/mL (TOBI)
- Nebcin 40 mg/ml injectable solution
Estado regulador
POM (Prescription Only Medicine)
POM-V
Sin datos reguladores para: 🇺🇸 US · 🇭🇰 HK · 🇹🇼 TW · 🇯🇵 JP · 🇰🇷 KR · 🇦🇺 AU
Almacenamiento y estabilidad
Store at room temperature (15-30°C); avoid freezing and temperatures above 40°C. Do not use the product if discolored.
Información para el cliente
La tobramicina es un antibiótico potente reservado para infecciones graves. Debido a su potencia, requiere un control cuidadoso para garantizar la seguridad de su mascota.
- Administración: Si se le ha indicado administrar inyecciones subcutáneas (debajo de la piel) en casa, asegúrese de comprender la técnica exacta y el programa de dosificación. Nunca administre más de lo recetado.
- Riesgos potenciales: Este medicamento conlleva el riesgo de causar daño renal y problemas de audición o equilibrio (ototoxicidad).
- Qué observar: Comuníquese con su veterinario de inmediato si nota cualquiera de los siguientes síntomas:
- Cambios en la micción (beber más, orinar más o orinar menos)
- Pérdida de equilibrio, tropiezos, inclinación de la cabeza o movimientos oculares anormales
- Pérdida de audición aparente o falta de respuesta a los sonidos
- Letargo, vómitos o pérdida de apetito
- Seguimiento: Asista a todas las citas para análisis de sangre y orina. Estas pruebas son cruciales para detectar signos tempranos de estrés renal antes de que ocurra un daño permanente.
La referencia de medicamentos de VetSheet está destinada a profesionales veterinarios autorizados como ayuda para la toma de decisiones clínicas, no como sustituto del criterio profesional ni del prospecto actual del fabricante.