Tobramycin Piperacillin

Krishnan RS, Lewis AT, Kass JS, Hsu S. Ultraviolet recall-hke phenomenon occurring after piperacillin, tobramycin, and ciprofloxacin therapy. J Am Acad Dermatol 2001 44(6) 1045-7. 

Ultraviolet recall has been reported after piperacillin, tobramycin, and ciprofloxacin, with a reaction pattern different from that of chemotherapy-induced reactions. 

Krishnan RS +, J Am Acad Dermatol 44, 1045 (with piperacillin tobramycin)... 

Ticarcillin, mezlocillin, or piperacillin tobramycin, gentamicin, or amikacin Penicillin G... 

Optimal antibiotic therapies for gram-negative bacillary meningitis have not been fully defined. Meningitis caused by Pseudomonas aeruginosa is initially treated with ceftazidime or cefepime, piperacillin + tazobactam, or meropenem plus an aminoglycoside, usually tobramycin. 

Aninoglycosides Gentamicin Tobramycin Amikacin Penicillins Ampicillin Ampicillin-sulbactam Ticarcillin-davulanate Piperacillin-tazobactam Cephalosporins, first-, second-, and third-generation... 

As long as there is no positive bacteriological result from the bile (or blood), antibiotics are administered on empirical and plausible principles. In this case, mezlocillin or piperacillin is initially recommended, 3x2 (-4 or -5) g/day, i.v. (55) These antibiotics are effective against virtually all bacteria in acute cholangitis, since they can reach high biliary concentrations. Once the course of disease has entered a more severe stage, an additional dose of tobramycin, for example, is indicated (e.g. 3 x 80 mg/day, i.v.). A septic clinical picture requires a course of triple therapy with ureidopenicillin + aminoglycoside (see above) + metronidazole (3 x 500 mg/ day, i.v.). 

Pickering LK, Rutherford I. Effect of couceutratiou aud time upon inactivation of tobramycin, gentamicin, netilmicin and amikacin by azlocillin, carbeniciUin, meciUinam, mezlocillin and piperacillin. I Pharmacol Exp Ther 1981 217(2) 345-9. 

Joshi M, Bernstein J, Solomkin J, Wester BA, Kuye O. Piperacillin/tazobactam plus tobramycin versus ceftazidime plus tobramycin for the treatment of patients with nosocomial lower respiratory tract infection. Piperacillin/ Tazobactam Nosocomial Pneumonia Study Group. J Antimicrob Chemother 1999 43(3) 389-97. 

Rotstein C, Cimrno M, Winkey K, Cesari C, Fenner J. Cefoperazone plus piperacillin versus mezlocillin plus tobramycin as empiric therapy for febrile episodes in neutropenic patients. Am J Med 1988 85(1 A) 36-43. 

Halstenson CE, Hirata CA, Heim-Duthoy KL, Abraham PA, Matzke GR. Effect of concomitant administration of piperacillin on the dispositions of netilmicin and tobramycin in patients with end-stage renal disease. Antimicrob Agents Chemother 1990 34(l) 128-33. 

Kureishi A, Jewesson PJ, Rubinger M, Cole CD, Reece DE, Phillips GL, Smith JA, Chow AW. Double-blind comparison of teicoplanin versus vancomycin in febrile neutropenic patients receiving concomitant tobramycin and piperacillin effect on cyclosporin A-associated nephrotoxicity. Antimicrob Agents Chemother 1991 35(ll) 2246-52. 

A 31-year-old woman with a Pseudomonas pneumonia was given intravenous ciprofloxacin 400 mg 12-hourly, tobramycin 400 mg/day, and piperacillin 4 g 6-hourly (37). Three days after the initial administration of the intravenous antibiotics, she developed a morbilliform eruption on the sun-exposed areas of her chest, back, and arms, corresponding to sites of intense sunburn that had occurred a month before. 

Concomitant administration of piperacillin and cephaloridine to rabbits resulted in a significant protective effect against cephaloridine nephrotoxicity [153]. Cephaloridine nephrotoxicity can be prevented by administration of other cephalosporins or penicdhns that produce little or no reduction of the cortical concentration of cephaloridine [154]. However, ceftriaxone protects against tobramycin nephrotoxicity by reducing the intracortical accumulation of tobramycin [155]. Combination of tobramycin with latamoxef protects the rat kidney from tobramycin nephrotoxicity, and the protective effect may be partially due to suppression of intrarenal accumulation of tobramycin by latamoxef. This suppression of nephrotoxicity is roughly dependent on the latamoxef dosage [81,156]. 

Indications Neuromuscular blockade, endotracheal intubation Category Non-depolarizing neuromuscular blocker Half-life initial 2 minutes terminal 20 minutes Clinically important, potentially hazardous interactions with amikacin, aminoglycosides, anesthetics, antibiotics, gentamicin, halothane, kanamycin, neomycin, piperacillin, streptomycin, tobramycin... 

Mpller NE, Eriksen KR, Feddersen C, et al. Chemotherapy against Pseudomonas aeruginosa in cystic fibrosis A study of carbenicillin, azlocillin, or piperacillin in combination with tobramycin. Eur J Respir Dis 1982 63 130-139. 

Peacock JE Jr, Herrington DA, Wade JC, et al. Ciprofloxacin plus piperacillin compared with tobramycin plus piperacillin as empirical therapy in febrile neutropenia patients A randomized, double-blind trial. Ann Intern Med 2002 137 77-87. 

A fluoroquinolone a tetracycline gentamicin A fluoroquinolone amikacin a tetracycline trimethoprim-sulfamethoxazole cefotaxime, ceftizoxime, ceftriaxone, cefepime, or ceftazidime Gentamicin, tobramycin or amikacin trimethoprim-sulfamethoxazole ciprofloxacin, ticarcillin, mezlocillin, or piperacillin aztreonam cefotaxime ceftizoxime ceftriaxone cefepime or ceftazidime Ampicillin gentamicin, tobramycin, or amikacin carbenicillin, ticarcillin, mezlocillin, or piperacillin gentamicin, tobramycin, or amikacin amoxicillin/clavulanic acid ticarcillin/clavulanic acid piperacillin/tazobactam ampicillin/sulbactam trimethoprim-sulfamethoxazole imipenem or meropenem aztreonam a fluoroquinolone another cephalosporin... 

An aminoglycoside ciprofloxacin trimethoprim-sulfamethoxazole ticarcillin, mezlocillin, or piperacillin ceftazidime minocycline doxycycline sulbactam polymyxin Gentamicin or tobramycin imipenem a fluoroquinolone Doxycycline azithromycin... 

Noninterfering amikacin, apalcillin, carbenicillin, cefoperazone, clindamycin, eiythromy-cin, gentamicin, penicillin, piperacillin, ticarcillin, tobramycin, vancomycin... 

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... 

Other reports similarly describe unusually low gentamicin levels in patients with impaired renal function, given carbenicillin, piperacillin," or ticarcillin. > >" The half-life of gentamicin has been reported to be reduced by carbenicillin or piperacillin by about one-half or one-third. >">" Similarly, unusually low tobramycin levels have been reported in patients with impaired renal function, who were given carbenicillin, piperacillin or ticarcillin."... 

In 3 patients receiving long-term haemodialysis piperacillin doubled the clearance of tobramycin 2 mg/kg, and reduced its half-life from 73 to 22 hours." A patient showed a reduction in the half-life of tobramycin from an expected 70 hours to 10.5 hours after being given piperacillin. In contrast one study found that piperacillin or piperacillin/tazobactam did not change the pharmacokinetics of tobramycin in subjects with renal impairment."... 

No interaction was seen in 10 patients given tobramycin with piperacillin, or in another 10 healthy subjects given once daily gentamicin with piperacillin/tazobactam. Only minimal pharmacokinetic changes were seen in 9 healthy subjects given tobramycin with piperacillin/tazobactam, and 18 cystic fibrosis patients (adults and children) given tobramycin with ticarcillin."... 

Uber W Brundage RC, White RL, Brundage DM, Bromley HR In vivo inactivation of tobramycin by piperacillin. Am Pharmacother ( 99 ) 25,357-9. 

Dowell JA, Koilh-Bradley J, Milisci M, Tantillo K, Am i P, Tse S Evaluating possible pharmacdcmedc interactions between tobramycin, piperacillin, and a combination oi piperacillin and tazobactam in patients with various d ees of renal impairment. ... 

Lau A, Lee M, Flascha S, Prasad R, Sharifl R. Effect of piperacillin on tobramycin pharmacokinetics in patients with nmnal renal function. Antimicrob Agents ChemoJrer (1983) 24, 533-7. 

Iven H, BraschH. Influence of the antibiotics piperacillin, doxycycline, and tobramycin on the pharmacokinetics of methotrexate in rabbits. Cancer ChemoAer Phamacol (i9Z6) 17, 218-22. 

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