Tobramycin in pediatric use

The new aminoglycoside antibiotic, tobramycin, was used for treatment of gram-negative and staphylococcal infection in 38 neonates, infants, and children in a pediatric surgical unit. Levels of drug in serum after administration by intramuscular, intravenous, and intraperitoneal routes were monitored, and control of infections was generally good within the therapeutic range of 2.0-10.0 mug/ml with a standard dosage regimen of approximately 5 mg/kg per day. Impairment of renal function and concurrent lincomycin therapy were important factors causing variation of levels in serum outside this range. Levels of tobramycin in cerebrospinal fluid after intraventricular instillation varied greatly in one patient, but were satisfactory in another. Clinical and bacteriological assessment of results indicated only two failures of treatment, although infection with a known resistant organism supervened in three cases. Screening for renal, hepatic, and hematological toxicity revealed only one case of transient and reversible renal impairment. Response to tobramycin therapy was generally rapid and satisfactory in a group of young patients with moderately severe infections, many of which were complicated by the presence of a congenital anomaly.