Clinical pharmacology of tobramycin in infants and children

Abstract

Tobramycin is an aminoglycoside antibiotic, binds to polysomes and interferes with bacterial protein synthesis causing misreading and premature termination of mRNA translation, it is bactericidal, has post-antibiotic effect on bacterial killing, and antimicrobial effect is concentration-dependent. This antibiotic may be administered orally, intravenously (either by slow injection or intravenous infusion), intramuscularly, applied to skin, and lung infections may be treated by inhalation. Tobramycin intravenous doses are: 5 mg/kg every 36 hours in infants, with a postmenstrual age < 32, and once-daily in older infants, and in children, doses are 2.5 and 3.5 mg/kg thrice-daily. Tobramycin effects are: increase of sodium excretion in the urine, tubular injury, and bronchoconstriction. This antibiotic well diffuses through all body organs, including the central nervous system, and successfully treated lung, kidney, ear, mouth, throat, eye, skin infections, rhinopharyngitis, and meningitis. Tobramycin peak and trough concentrations should be > 10 and < 2 µg/ml, respectively, in order to yield antimicrobial effect and to keep toxicity low. Optimization of treatment has been recommended in order to keep serum concentrations within the therapeutic-interval as they vary in infants and children. Tobramycin half-life is longer in infants (about 10 hours) than in children. Some organisms may become resistant to tobramycin. The aim of this study is to review published data on tobramycin dosing, efficacy, safety, effects, adverse-effects, drug-interactions, treatment optimization, trials, meningitis, pharmacodynamics, pharmacokinetics, and bacterial-resistance in infants and children.