Section 7
Chapter 6,812

Tobramycin dosing in the puerperal patient

Pastorek, J.G.; Ragan, F.A.; Phelan, M.

Journal of Reproductive Medicine 32(5): 343-346


ISSN/ISBN: 0024-7758
PMID: 3598982
Accession: 006811620

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Serum levels of tobramycin were determined with an enzyme immunoassay technique in 20 puerperal women with postcesarean endometritis who were being treated with metronidazole-tobramycin. Ideal dosing was then calculated to attempt to provide peak serum levels between 5 and 8 micrograms/mL and trough serum levels less than 2 micrograms/mL. In eight patients, therapeutic serum levels could not be attained even at doses greater than the package-insert recommendation of 3 mg/kg/d. Therapeutic levels were achieved in five patients with doses between 3 and 5 mg/kg/d and in seven patients only at doses above the maximum recommended daily dose of 5 mg/kg. The puerperal patient appears to usually require much higher dosages of tobramycin than usual, and serum levels must be monitored for therapeutic reasons rather than for toxicity.

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