Tobramycin Vancomycin

Clinically important, potentially hazardous interactions with amikacin, aminoglycosides, galantamine, gentamicin, kanamycin, neomycin, paromomycin, physostigmine, pipecuronium, streptomycin, tobramycin, vancomycin, vecuronium... 

Noninterfering acetaminophen, amikacin, ceftazidime, ceftriaxone, genteimicin, nafcillin, phenytoin, ticarcillin, tobramycin, vancomycin... 

Extracted cefamandole, cefazolin, cefoxitin, cephapirin, chloramphenicol Simultaneous acetaminophen, N-acetylprocainamide, cefaclor, cephalexin, cephalothin, ci-metidine, miconazole, moxalactam, procainamide, sulfamethoxazole, theophylline, tobramycin, vancomycin... 

Noninterfering amikadn, carbenicillin, cefazolin, cefoperazine, cefoxitin, chloramphenicol, ciprofloxacin, gentamicin, imipenem, moxalactam, oxacillin, ticeircillin, tobramycin, vancomycin... 

Tobramycin, gentamicin Amikacin Vancomycin 10-12 30-40 C Less than 1.5 Less than 5.0 10-15 21.4-25.7 35.1-46.8 C Less than 3.2 Less than 5.85 7-10.35... 

Empirical therapy for postoperative infections in neurosurgical patients (including patients with CSF shunts) should include vancomycin in combination with either cefepime, ceftazidime, or meropenem. Linezolid has been reported to reach adequate CSF concentrations and resolve cases of meningitis refractory to vancomycin.35 However, data with linezolid are limited. The addition of rifampin should be considered for treatment of shunt infections. When culture and sensitivity data are available, pathogen-directed antibiotic therapy should be administered. Removal of infected devices is desirable aggressive antibiotic therapy (including high-dose intravenous antibiotic therapy plus intraventricular vancomycin and/or tobramycin) may be effective for patients in whom hardware removal is not possible.36... 

Solutions of cefepime, like those of most -lactam antibiotics, should not be added to solutions of ampicillin at a concentration greater than 40 mg/mL, and should not be added to metronidazole, vancomycin, gentamicin, tobramycin, netilmicin sulfate, or aminophylline because of potential interaction. However, if concurrent therapy with cefepime is indicated, each of these antibiotics can be administered separately. P.877... 

When catheter-related septicemia is suspected or proven vancomycin ((2-3) x I g) is started while vancomycin trough levels are monitored. Removal of the catheter must be considered with persistent fever or when blood cultures remain positive under effective vancomycin trough levels (10-15 mg/1). In a rapidly progressive infection (pneumonia) in a neutropenic patient anti-pseudomonas duo-therapy, e.g. ceftazidime with tobramycin, should be considered. 

The aminoglycosides include streptomycin, neomycin, kanamycin, amikacin, gentamicin, tobramycin, sisomicin, netilmicin, and others. They are used most widely against gram-negative enteric bacteria, especially in bacteremia and sepsis, in combination with vancomycin or a penicillin for endocarditis, and for treatment of tuberculosis. 

Heparin and its salts are incompatible with many drugs including alteplase, amikacin sulfate, amiodarone hydrochloride, ampicillin sodium, aprotinin, benzylpenicillin potassium or sodium, cephalothin sodium, ciprofloxacin lactate, cytarabine, dacarbazine, daunorubicin hydrochloride, diazepam, dobutamine hydrochloride, doxorubicin hydrochloride, droperidol, erythromycin lactobionate, gentamicin sulfate, haloperidol lactate, hyaluronidase, hydrocortisone sodium succinate, kanamycin sulfate, methicillin sodium, netilmicin sulfate, some opioid analgesics, oxytetracycline hydrochloride, some phenothiazines, polymyxin B sulfate, streptomycin sulfate, tetracycline hydrochloride, tobramycin sulfate, vancomycin hydrochloride, vinblastine sulfate, cisatracurium besylate, labetalol hydrochloride, nicardipine hydrochloride, cefmetazole, sodium ions, and fat emulsion.110 112... 

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. 

Yano Y, Hiraoka A, OgumaT, Enhancement of tobramycin binding to rat renal brush border membrane by vancomycin, J Pharmacol Exp Ther, 1995,274 695-99. 

As empiric therapy for sepsis and the leg ulcer, BK is started on vancomycin 1 g intravenously (iV) every 12 hours and tobramycin 100 mg IV every 8 hours. 

Should vancomycin or tobramycin therapy be initiated with a "loading" dose ... 

Presentation 1 Conclusion Both vancomycin and tobramycin are adnriinistered with dosing intervals that are longer than the drugs T54. Under these conditions there is little accumulation, and loading doses are not usually administered. Both vancomycin and tobramycin are eliminated from the body primarily by the renal route. BK is a 72-year-old man with a serum Cr level of 2.4 mgAjL As a first estimate, his renal function would appear to be approximately half of the normal value. Using the equation that accounts for age, body size, sex, and serum Cr, his estimated CrCI rate is expected to be approximately 25 ml/min. 

Assuming 100 mL/min to be the normal" value, BK s renal functiori is only about one fourth of normal. Clearly some type of dose adjustment seems warranted for both vancomycin and tobramycin. The question is whether to decrease the dose and maintain the same interval or to keep the same dose and increase the interval, in any case, we would expect to administer the two drugs at about one fourth the usual rate. 

Other antimicrobial agents that have been incorporated into PMMA beads and shown to have useful elution profiles include penicillin G (ben-zylpenicillin), ampicillin, amoxicillin, flucloxacillin, amoxiciUin-clavulanate, cefamandole, cefazolin, tobramycin, netilmicin, imipenem, erythromycin, ciprofloxacin, trimethoprim-sulfamethoxazole, chloramphenicol and vancomycin (Ethell et al 2000, Mader et al 1997, Veyries et al 2000). 

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