Tobramycin, Random, Serum
Clinical Information Discusses physiology, pathophysiology, and general clinical aspects, as they relate to a laboratory test
Tobramycin is an antibiotic used to treat life-threatening blood infections by gram-negative bacilli, particularly Citrobacter freundii, Enterobacter (all species), Escherichia coli, Klebsiella pneumoniae, Proteus mirabilis, Providencia stuartii, Pseudomonas aeruginosa, and Serratia. It is often used in combination with beta-lactam therapy.
A tobramycin minimum inhibitory concentration (MIC) of <4.0 mcg/mL is considered susceptible for gram-negative bacilli, while an MIC of >8.0 mcg/mL is considered resistant.
Toxicities include ototoxicity and nephrotoxicity. This risk is enhanced in presence of other ototoxic or nephrotoxic drugs. Monitoring of serum levels, renal function, and symptoms consistent with ototoxicity is important. For longer durations of use, audiology and vestibular testing should be considered at baseline and periodically during therapy.
Monitoring adequacy of serum concentration during tobramycin therapy
This unit code is used whenever a specimen is submitted or collected without collection timing information. The phlebotomist should use this unit code if she or he does not know if this is a peak or trough specimen.
Target peak concentrations depend on the type of infection being treated. Goal trough levels should be <2.0 mcg/mL. Concentrations refer to conventional (non-pulse) dosing. Prolonged exposure to either peak levels exceeding 12.0 mcg/mL or trough levels exceeding 2.0 mcg/mL may lead to toxicity.
Cautions Discusses conditions that may cause diagnostic confusion, including improper specimen collection and handling, inappropriate test selection, and interfering substances
No significant cautionary statements
Reference Values Describes reference intervals and additional information for interpretation of test results. May include intervals based on age and sex when appropriate. Intervals are Mayo-derived, unless otherwise designated. If an interpretive report is provided, the reference value field will state this.
Therapeutic: 5.0-12.0 mcg/mL
Therapeutic: <2.0 mcg/mL
Clinical References Provides recommendations for further in-depth reading of a clinical nature
1. Hammett-Stabler CA, Johns T: Laboratory Guidelines for Monitoring of Antimicrobial Drugs. Clinical Chemistry 1998;44(5):1129-1140
2. Moyer TP: Therapeutic drug monitoring. In Tietz Textbook of Clinical Chemistry. Fourth edition. Edited by CA Burtis, ER Ashwood, Philadelphia, WB Saunders Company, 2006
3. Wilson JW, Estes LL: Mayo Clinic Antimicrobial Therapy Quick Guide. Mayo Clinic Scientific Press and Informa Healthcare USA, 2008