Indications: Chronic pulmonary Pseudomonas aeruginosa infection in patients with cystic fibrosis.

Cautions: Other inhaled drugs should be administered before tobramycin. Measure lung function before and after initial dose of tobramycin and monitor for bronchospasm; if bronchospasm occurs in a patient not using a bronchodilator, repeat test using bronchodilator. Monitor renal function before treatment and then annually. Severe haemoptysis—risk of further haemorrhage.

Contra-indications: myasthenia gravis

Side Effects: on inhalation, cough (more frequent by inhalation of powder), bronchospasm, dysphonia, taste disturbances, pharyngitis, mouth ulcers, salivary hypersecretion, laryngitis, haemoptysis, epistaxis.

Pregnancy: Second and third trimester: Auditory or vestibular nerve damage.

Dose: by inhalation of nebulised solution, adult and child over 6 years, 300 mg every 12 hours for 28 days, subsequent courses repeated after 28-day interval without tobramycin nebuliser solution