VetSheet

토브라마이신

Tobramycin

Tobramycin sulfate

아미노글리코사이드계 항생제IVIMSCtopicalinhalationophthalmic개고양이소형 포유류새파충류말

다른 이름: TOBI · Brulamycin · Gernebcin · Mytobrin · Tobrex · tobramycin sulphate · Tobramycinum

VetSheet 수의사 팀 검수업데이트 2026년 4월 5일근거 기반 수의학 참고자료

WHO 최우선 중요 항생제 — 신중하게 사용하고 불필요한 처방 회피
2 mg/kgIV, IM, SC· q8h
— 🐕

용량은 수의사 전문가를 위한 임상 참고자료입니다. 반드시 최신 약물 정보 및 개별 환자에 따라 확인하시기 바랍니다.

동물 종별 용량

🌎 NA — North America🌍 EU — Europe

개

적응증용량경로빈도기간지역
General susceptible infections2 mg/kgIV, IM, SCq8h—🌎 NA
Susceptible UTI1-2 mg/kgSCq8h—🌎 NA
Sepsis2-4 mg/kgIVq8h—🌎 NA
Soft tissue, systemic infections1-1.7 mg/kg IV q8h or 3-5.1 mg/kg IV q24hIVq8h or q24h< 7 days🌎 NA
Systemic infections2 mg/kg SC q8-12h or 4-6 mg/kg SC q24hSCq8-12h or q24h< 7 days🌎 NA
Persistent bacteremia3-5 mg/kg IV, IM, SC q8h or 9-15 mg/kg IV, IM or SC q24hIV, IM, SCq8h or q24h<= 7 days🌎 NA
Gram-negative infections4-6 mg/kgIV/IM/SCq24hAssess 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.

고양이

적응증용량경로빈도기간지역
General susceptible infections2 mg/kgIV, IM, SCq8h—🌎 NA
Susceptible UTI1-2 mg/kgSCq8h—🌎 NA
Sepsis2-4 mg/kgIVq8h—🌎 NA
Soft tissue, systemic infections2 mg/kg IV, IM or SC q12h or 4 mg/kg IV, IM, SC q24hIV, IM, SCq12h or q24h<= 5 days🌎 NA
Persistent bacteremia2 mg/kg IV, IM, SC q8h or 6 mg/kg IV, IM or SC q24hIV, IM, SCq8h or q24h<= 5 days🌎 NA
Gram-negative infections4-6 mg/kgIV/IM/SCq24hAssess 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.

소형 포유류

적응증용량경로빈도기간지역
Susceptible infections (Llamas)4 mg/kg IV q24h; 0.75 mg/kg IV q8hIVq8h or q24h—🌎 NA
  • Susceptible infections (Llamas): Dosing specifically for Llamas.

새

적응증용량경로빈도기간지역
Susceptible infections5 mg/kgIMq12h—🌎 NA
Susceptible infections2.5-5 mg/kg/dayParenteralDaily—🌎 NA

파충류

적응증용량경로빈도기간지역
Susceptible infections2.5 mg/kgIMq24h—🌎 NA

말

적응증용량경로빈도기간지역
Susceptible infections4 mg/kgIVq24h—🌎 NA
  • Susceptible infections: Allows achievement of Cmax/MIC ratio higher than 10 for pathogen strains with a MIC of 1 microgram/mL.

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개요

토브라마이신은 주로 심각한 그람 음성 호기성 세균 감염에 탁월한 효능을 나타내는 강력한 비경구용 ​아미노글리코사이드계 항생제​입니다.

​주요 임상적 특징:​

  • ​항균 스펙트럼:​ 호기성 그람 음성 간균(예: 녹농균, 대장균, 클레브시엘라, 프로테우스) 및 일부 호기성 그람 양성균(예: 포도상구균)에 매우 효과적입니다. 혐기성 세균 및 진균에는 효과가 없습니다.
  • ​임상적 유용성:​ 내재된 독성으로 인해 전신적 사용은 일반적으로 독성이 적은 다른 항생제가 듣지 않는 심각하고 생명을 위협하는 감염이나 알려진 겐타마이신 내성 균주를 치료할 때로 제한됩니다.
  • ​독성 프로파일:​ 모든 아미노글리코사이드계와 마찬가지로 ​신독성​ 및 ​이독성​의 심각한 위험을 수반합니다. 일부 실험실 증거에 따르면 겐타마이신보다 신독성이 약간 낮을 수 있지만 임상적으로는 여전히 논란의 여지가 있습니다.

​임상 핵심:​ 아미노글리코사이드계는 ​농도 의존적 살균 활성​과 유의미한 ​항생제 후 효과(PAE)​를 나타냅니다. 이러한 약동학/약력학적 프로파일은 현대의 고용량, 연장된 간격(1일 1회) 투여 방식을 강력히 뒷받침합니다. 이 접근법은 세균 사멸을 위한 $C_{max}$/MIC 비율을 최대화하는 동시에 신세뇨관 세포가 약물을 제거할 수 있는 휴약 기간을 제공하여 신독성을 최소화합니다.

작용 기전

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.

안전성·주의사항

금기사항

  • 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)

부작용

  • 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)

주의

​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.

약물 상호작용

Beta-lactam antibiotics (penicillins, cephalosporins)Moderate

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.

Cephalosporins

Potential for additive nephrotoxicity (historically documented with older generation cephalosporins like cephalothin).

Loop Diuretics (furosemide, torsemide)

Increased risk of nephrotoxicity and ototoxicity.

Osmotic Diuretics (mannitol)

Increased risk of nephrotoxicity and ototoxicity.

Other Nephrotoxic Drugs (cisplatin, amphotericin B, polymyxin B, vancomycin)

Significantly increased risk of acute kidney injury.

Neuromuscular Blocking Agents & General Anesthetics

Concomitant use can potentiate and prolong neuromuscular blockade, potentially leading to respiratory paralysis.

Amphotericin BMajor

Increased risk of nephrotoxicity

FurosemideMajor

Increased risk of ototoxicity and nephrotoxicity

HeparinMinor

In vitro chemical inactivation if mixed

PancuroniumModerate

Enhanced non-depolarizing neuromuscular blockade

모니터링

  • 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

약동학

반감기

고양이1-2 hours개1-2 hours말2.5-4 hours

흡수

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.

분포

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.

대사

Aminoglycosides are not significantly metabolized.

배설

Eliminated almost entirely by glomerular filtration. Clearance (horses): 101-130 mL/kg/hr. Patients with decreased renal function can have significantly prolonged half-lives.

과다투여

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.

제품

제형

  • Injection solution
  • Powder for injection
  • Inhalation solution
  • Ophthalmic preparations
  • Injectable: 40 mg/ml solution

동물용의약품

  • Tobramycin 40 mg/ml injectable solution

인용의약품

  • 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

규제 현황

European Union✓ 승인됨처방전의약품EMA
🐕 Dogs🐈 Cats

POM (Prescription Only Medicine)

United Kingdom✓ 승인됨처방전의약품VMD
🐕 Dogs🐈 Cats

POM-V

규제 데이터 없음: 🇺🇸 US · 🇭🇰 HK · 🇹🇼 TW · 🇯🇵 JP · 🇰🇷 KR · 🇦🇺 AU

보관·안정성

Store at room temperature (15-30°C); avoid freezing and temperatures above 40°C. Do not use the product if discolored.

보호자 정보

토브라마이신은 심각한 감염에 사용하도록 제한된 강력한 항생제입니다. 약효가 강력하기 때문에 반려동물의 안전을 보장하기 위해 세심한 모니터링이 필요합니다.

  • ​투여 방법:​ 집에서 피하 주사를 하도록 지시받은 경우, 정확한 주사 기술과 투여 일정을 완전히 이해해야 합니다. 처방된 용량 이상을 투여하지 마십시오.
  • ​잠재적 위험:​ 이 약물은 ​신장 손상​ 및 ​청력 또는 균형 문제​(이독성)를 유발할 위험이 있습니다.
  • ​주의 깊게 관찰할 사항:​ 다음 중 하나라도 발견되면 즉시 수의사에게 연락하십시오:
    • 배뇨 변화(물을 더 많이 마시거나, 소변을 더 많이 보거나, 덜 보는 경우)
    • 균형 상실, 비틀거림, 머리 기울어짐 또는 비정상적인 안구 운동
    • 명백한 청력 상실 또는 소리에 대한 무반응
    • 무기력, 구토 또는 식욕 부진
  • ​후속 조치:​ 혈액 및 소변 검사 예약을 반드시 지키십시오. 이러한 검사는 영구적인 손상이 발생하기 전에 신장 스트레스의 초기 징후를 포착하는 데 매우 중요합니다.

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