Tobramycin - systemic

According to infection severity: conventional 1.5-2.5 mg/kg per dose every 8-12 hours; once-daily 4-7 mg/kg every 24 hours.

Patient-specific pharmacokinetic calculations and serum concentrations are preferred. Conventional dosing, usual dose at the stated interval: CrCl above 60 mL/min every 8 hours; 40-60 every 12 hours; 20-40 every 24 hours; 10-20 every 48 hours; below 10 every 48-72 hours. A later repeated source table specifies every 72 hours below 10.

High-dose therapy: above 60 usual dose; below 60 extend the interval using concentrations. The later discussion gives every 48 hours as an example at CrCl 30-59, with concentration-guided adjustment.

Whenever possible monitor serum concentrations. After a 1 mg/kg loading dose, either reduce the dose at an 8-hour interval or give normal doses at longer intervals. The creatinine-based methods are only guides when concentrations cannot be measured, require clinical/laboratory observation and modification, and must not be used during dialysis.

At CrCl 70 mL/min or less, the source refers to a reduced-dose nomogram. An alternative rough steady-state-serum-creatinine rule is usual dose divided by serum creatinine, given every 8 hours. When CrCl is unavailable and the patient is stable, its rough normal-dose interval in hours is serum creatinine multiplied by 6.

The original nomogram image was inspected: its clearance axis is indexed in mL/min/1.73 m2, serum-creatinine axis is mg/100 mL, and vertical axis is percentage of normal dose. It notes that scales were adjusted to facilitate calculations. The image itself is not bundled and no dose has been interpolated from it.

Approximately 30% removal during 4 hours. Dose after HD and follow levels. The source gives half a full dose after each HD session as a sample recommendation, not a universal patient-specific calculation.