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Tobramycin (Ophthalmic)

Medically reviewed by Drugs.com. Last updated on July 18, 2020.

Pronunciation

(toe bra MYE sin)

Index Terms

  • Tobramycin Sulfate

Dosage Forms

Excipient information presented when available (limited, particularly for generics); consult specific product labeling.

Ointment, Ophthalmic:

Tobrex: 0.3% (3.5 g)

Solution, Ophthalmic:

Tobrex: 0.3% (5 mL)

Generic: 0.3% (5 mL)

Brand Names: U.S.

  • Tobrex

Pharmacologic Category

  • Antibiotic, Aminoglycoside
  • Antibiotic, Ophthalmic

Pharmacology

Interferes with bacterial protein synthesis by binding to 30S ribosomal subunit resulting in a defective bacterial cell membrane

Absorption

Systemic absorption: Undetectable (<0.2 mcg/mL) (Filatov 1994); tear film exposure and time above MIC90 are significantly greater with viscous ophthalmic solution [Canadian product] (Tobrexan Canadian product labeling 2016).

Use: Labeled Indications

Ocular infections: Treatment of external infections of the eye and its adnexa caused by susceptible bacteria.

Contraindications

Hypersensitivity to tobramycin or any component of the formulation

Canadian labeling: Additional contraindications (not in US labeling): Known hypersensitivity to any aminoglycoside

Dosing: Adult

Ocular infections: Ophthalmic:

Ointment: Apply half-inch ribbon into affected eye(s) 2 or 3 times daily for mild to moderate infections; for severe infections, apply every 3 to 4 hours until improvement (then reduce prior to discontinuation).

Solution: Instill 1 to 2 drops into affected eye(s) every 4 hours for mild to moderate infections; for severe infections, instill 2 drops every hour until improvement (then reduce prior to discontinuation).

Viscous solution (Tobrexan [Canadian product]): Instill 1 drop into affected eye(s) 2 times daily for 7 days for mild to moderate infections; for severe infections, instill 1 drop 4 times daily on day 1 and then 2 times daily for duration of treatment period.

Dosing: Pediatric

Ocular infections: Ophthalmic: Infants ≥2 months, Children, and Adolescents:

Ointment:

Mild to moderate infections: Apply 1/2 inch ribbon into the affected eye(s) 2 to 3 times daily

Severe infections: Apply 1/2 inch ribbon into the affected eye(s) every 3 to 4 hours initially until improvement, then reduce to less frequent intervals prior to discontinuation

Solution:

Mild to moderate infections: Instill 1 to 2 drops into the affected eye(s) every 4 hours

Severe infections: Instill 2 drops into the affected eye(s) every hour initially until improvement, then reduce to less frequent intervals prior to discontinuation

Administration

For topical ophthalmic use only; not for injection into the eye. Contact lenses should not be worn during treatment of ophthalmic infections. Avoid contaminating the applicator tip with affected eye(s).

Ointment: Apply into conjunctival sac(s) of eye; patient should look downward before closing eye.

Storage

Store at 2°C to 25°C (36°F to 77°F).

Drug Interactions

There are no known significant interactions.

Adverse Reactions

The following adverse drug reactions and incidences are derived from product labeling unless otherwise specified.

<1%:

Hypersensitivity: Hypersensitivity reaction

Ophthalmic: Conjunctival erythema, eyelid edema, eyelid pruritus, ocular toxicity (localized)

Postmarketing:

Dermatologic: Erythema multiforme, Stevens-Johnson syndrome

Hypersensitivity: Anaphylaxis

Warnings/Precautions

Concerns related to adverse effects:

• Hypersensitivity reactions: Sensitivity varying from local to generalized effects (eg, erythema, pruritus, urticaria, skin rash, anaphylaxis, anaphylactoid reaction, bullous reaction) to topically applied aminoglycosides and cross sensitivity to other aminoglycosides antibiotics may occur; discontinue use if hypersensitivity develops.

• Superinfection: Prolonged use may lead to overgrowth of nonsusceptible organisms, including fungi. If superinfection is suspected, institute appropriate alternative therapy.

Special populations:

• Contact lens wearers: Some products may contain benzalkonium chloride or benzododecinium bromide which may be absorbed by soft contact lenses; contact lenses should not be worn during treatment of ophthalmologic infections.

Other warnings/precautions:

• Appropriate use: For topical application to the eye only; not for injection. To avoid contamination, do not touch tip of container to any surface.

Pregnancy Considerations

Adverse events have not been observed in animal reproduction studies. The amount of tobramycin available systemically following topical application of the ophthalmic drops is undetectable (<0.2 mcg/mL) (Filatov 1994). If ophthalmic agents are needed during pregnancy, the minimum effective dose should be used in combination with punctal occlusion to decrease systemic absorption (Samples 1988).

Patient Education

What is this drug used for?

• It is used to treat eye infections.

WARNING/CAUTION: Even though it may be rare, some people may have very bad and sometimes deadly side effects when taking a drug. Tell your doctor or get medical help right away if you have any of the following signs or symptoms that may be related to a very bad side effect:

• Vision changes

• Eye pain

• Severe eye irritation

• Signs of an allergic reaction, like rash; hives; itching; red, swollen, blistered, or peeling skin with or without fever; wheezing; tightness in the chest or throat; trouble breathing, swallowing, or talking; unusual hoarseness; or swelling of the mouth, face, lips, tongue, or throat.

Note: This is not a comprehensive list of all side effects. Talk to your doctor if you have questions.

Consumer Information Use and Disclaimer: This information should not be used to decide whether or not to take this medicine or any other medicine. Only the healthcare provider has the knowledge and training to decide which medicines are right for a specific patient. This information does not endorse any medicine as safe, effective, or approved for treating any patient or health condition. This is only a limited summary of general information about the medicine's uses from the patient education leaflet and is not intended to be comprehensive. This limited summary does NOT include all information available about the possible uses, directions, warnings, precautions, interactions, adverse effects, or risks that may apply to this medicine. This information is not intended to provide medical advice, diagnosis or treatment and does not replace information you receive from the healthcare provider. For a more detailed summary of information about the risks and benefits of using this medicine, please speak with your healthcare provider and review the entire patient education leaflet.

Further information

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.