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Inhaled Antibiotics — Bronchiectasis & Cystic Fibrosis Pregnancy: Aminoglycosides can cause fetal harm; published literature reports irreversible bilateral congenital deafness with streptomycin in pregnancy. There are no available data on inhaled tobramycin in pregnant women, although systemic absorption after inhalation is expected to be minimal. Advise pregnant women of the potential risk to a fetus.

Tobramycin Inhalation

Brand names: TOBI, TOBI Podhaler, Bramitob

Inhaled tobramycin is a nebuliser solution or dry-powder aminoglycoside antibiotic used for chronic Pseudomonas aeruginosa lung infection, chiefly in cystic fibrosis. The inhaled route delivers high airway concentrations while limiting systemic exposure.

Auto-extracted from the source labelling — not yet independently clinician-verified. These values were distilled from the UK SPC (or the US label where noted) but have not had a clinician sign-off. Confirm against the current SmPC before prescribing.

Adult dose

Dose: 300 mg (one 5 mL single-dose ampule) per dose
Route: Oral inhalation only, nebulised over approximately 15 minutes using a hand-held PARI LC PLUS Reusable Nebulizer with a DeVilbiss Pulmo-Aide compressor. Not for subcutaneous, intravenous or intrathecal administration.
Frequency: Twice daily, in alternating cycles of 28 days on drug followed by 28 days off drug. Doses should be taken as close to 12 hours apart as possible and not less than 6 hours apart.
The recommended dosage is the same for adults and paediatric patients 6 years of age and older: one 300 mg ampule twice daily for 28 days, then stop for the next 28 days, then resume the 28-day-on/28-day-off cycle. 'Dosage is not adjusted by weight. All patients should be administered 300 mg twice daily.' Safety and efficacy in children under 6 years have not been established and use is not indicated in children <6 years. Missed dose: take as soon as possible any time up to 6 hours before the next scheduled dose; if less than 6 hours remain, wait for the next scheduled dose. Do not dilute or mix with dornase alfa or other medications in the nebuliser. Do not use if the solution is cloudy, if there are particles in it, or if it has been stored at room temperature for more than 28 days. Patients on multiple therapies should take their other medications before inhaling tobramycin, or as directed by their physician. No UK SPC (eMC) record was retrieved in this bundle — the dose above is from US prescribing information and must be verified against UK labelling.

Dose auto-extracted from US FDA prescribing information (openFDA / DailyMed) — cross-check; US labelling may differ from UK — not yet clinician-verified. Always confirm against the product SmPC and your local formulary before prescribing.

Contraindications

  • Known hypersensitivity to any aminoglycoside

Side effects

  • Increased cough and bronchospasm
  • Pharyngitis and increased sputum
  • Dyspnoea, haemoptysis and decreased lung function
  • Voice alteration and taste perversion
  • Rash; ototoxicity (tinnitus, hearing loss) and nephrotoxicity have also been reported

Interactions

  • Avoid concurrent and/or sequential use with other drugs with neurotoxic, nephrotoxic or ototoxic potential
  • Do not administer concomitantly with ethacrynic acid, furosemide, urea or intravenous mannitol — these diuretics can enhance aminoglycoside toxicity (the interaction between inhaled mannitol and inhaled tobramycin has not been evaluated)

Clinical monograph

How it works

Tobramycin binds the bacterial 30S ribosomal subunit to inhibit protein synthesis, giving concentration-dependent bactericidal activity against Pseudomonas and other Gram-negative organisms.

Prescribing in practice

  • Inhalation can trigger bronchospasm, so the first dose should be supervised with a bronchodilator available and lung function assessed.
  • Although systemic absorption is low, caution and consideration of monitoring apply with concurrent or recent systemic aminoglycosides given cumulative oto- and nephrotoxicity risk.
  • It is given in intermittent on/off treatment cycles and a bronchodilator may be advised before each dose in reactive airways.

Monitoring

Monitor for bronchospasm and audiometric or renal effects where systemic aminoglycoside exposure is also possible, and review sputum microbiology.

Counselling the patient

  • Use any prescribed bronchodilator first and follow the on/off cycle exactly as directed.
  • Report new hearing changes, ringing in the ears or dizziness.

Evidence & guidelines

Inhaled tobramycin is supported by cystic fibrosis trial evidence and guideline endorsement for suppressing chronic Pseudomonas infection and preserving lung function.

Reference: NICE CF Guideline NG78; MHRA SPC TOBI; Cystic Fibrosis Trust Antibiotic Guidelines; EMBARC Bronchiectasis Guidelines 2017; Confirm identity and dosing against the manufacturer SPC (eMC) and NICE. Verify against your local formulary and current prescribing references before prescribing. The structured dose values shown have been reviewed by a clinician. Monograph status: clinician-reviewed (2026-07-04).

Related

Curated clinical cross-links plus same-class fallbacks.

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