Bruun J N, Eng J, Arnesen A R
Scand J Infect Dis. 1981;13(1):59-64. doi: 10.1080/00365548.1981.11690368.
Plasma concentrations and side effects were followed in 52 adults treated with tobramycin for 4-39 days (mean 12.2 days). In order to obtain 1-h peak levels above the recommended 4 microgram/ml in patients with normal renal function, loading doses of 160 mg followed by 100-120 mg every 8 h were usually necessary. Both the leading dose and the mean daily dose of 304 mg were higher than usually recommended. Great individual variations in doses required were found and nomograms were of little value. Reduced maintenance doses were given to patients with impaired renal function. Adequate treatment required plasma level determinations 2-3 times a week. The high dose of tobramycin regimen used in this study implied that 30% of the trough levels exceeded 2 microgram/ml. The frequency of clinically significant side effects were, however, low and the treatment was only interrupted once because of a decrease in renal function. Temporary reduction in renal function probably related to tobramycin was found in 6 patients, and 5 patients got temporary disturbances of vestibular function. One patient experienced a temporary hearing loss and 2 patients a permanent hearing loss, which might have been caused by simultaneous treatment with furosemide and tobramycin.
对52例接受妥布霉素治疗4 - 39天（平均12.2天）的成年人进行了血浆浓度和副作用监测。为使肾功能正常的患者1小时峰值水平高于推荐的4微克/毫升，通常需要先给予160毫克的负荷剂量，随后每8小时给予100 - 120毫克。负荷剂量和平均每日剂量304毫克均高于通常推荐剂量。发现所需剂量存在很大个体差异，列线图价值不大。肾功能受损的患者给予降低的维持剂量。充分治疗需要每周进行2 - 3次血浆水平测定。本研究中使用的高剂量妥布霉素方案意味着30%的谷浓度超过2微克/毫升。然而，具有临床意义的副作用发生率较低，仅因肾功能下降而中断治疗一次。6例患者出现可能与妥布霉素有关的肾功能暂时下降，5例患者出现前庭功能暂时紊乱。1例患者出现暂时性听力丧失，2例患者出现永久性听力丧失，这可能是同时使用速尿和妥布霉素所致。
