Tobramycin Amphotericin

Clinically important, potentially hazardous interactions with amikacin, amphotericin B, delavirdine, drugs causing kidney toxicity, foscarnet, gentamicin, hydroxyurea, pentamidine, tobramycin... 

Noninterfering acetaminophen, acyclovir, allopurinol, amoxicillin, amphotericin B, am-picillin, aspirin, azlocillin, bendrofluazide, bumetanide, buprenorphine, carbenidllin, cefazolin, cefotaxime, cefoxitin, ceftazidime, cefuroxime, cephalexin, chlorambucil, chloramphenicol, chlordiazepoxide, chlorpheniramine, chlorpropamide, cyclophosphamide, cyclosporin, C5d arabine, daunorubicin, dextropropoxyphene, dihydrocodeine, domperidone, flucytosine, furosemide, gentamicin, griseofulvin, melphalan, methotrexate, metochlo-pramide, metronidazole, miconazole, nabilone, netilmicin, nicotinamide, nitrazepam, penicillin G, piperacillin, prednisolone, procarbeizine, prochlorperazine, riboflavin, rifampin, sulfamethoxazole, thioguanine, tobramycin, tolbutamide, trimethoprim... 

Nephrotoxicity Renal toxicity usually takes the form of acute tubular necrosis. This adverse effect, which is often reversible, is more common in elderly patients and in those concurrently receiving amphotericin B, cephalosporins, or vancomycin. Gentamicin and tobramycin are the most nephrotoxic. 

A study assessing the risk factors for nephrotoxicity with aminoglycosides (tobramycin and gentamicin) enrolled 1489 patients, 157 of whom developed clinical nephrotoxicity. Of these patients 118 had no immediately identifiable cause (sueh as acute renal failure) and further evaluation of other risk factors found that the concurrent use of amphotericin B significantly increased the risk of nephrotoxicity. ... 

Administration devices for medicines used to treat asthma and COPD are prescriptirm products, with an exception for some nebulised (medicine) formulations. Medicines such as amphotericin B or antibiotics (coUstimethate sodium, tobramycin sulphate or gentamicin) for nebulisation in CF therapy are sometimes stUl partly prepared by hospital pharmacists, and so are nebulised solutions for bronchial challenge testing. Although product formulation and the method of preparation of formulations for inhalation are not the main subjects of this chapter, recommendations are given in the subparagraphs about nebulisation. 

Abbreviations. Antibiotics A = amphotericin B CZA = ceftazidime G = gentamicin N = norfloxacin Nal = nalidixic acid Neo Nys = nystatin O = ofloxacin P = polymixin T = tobramycin CFX = cefotaxime O = ofloxacin Trim = trimethoprim. Surveillance Etr = endotracheal aspirate G = gastric aspirate O = oropharynx R = rectal swab U = urine W = wound swab. 

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