Tobrex (Tobramycin) – Ophthalmic

What Is Tobrex?

Tobrex (tobramycin) is a prescription medication that belongs to the aminoglycoside antibiotics drugs class. Tobrex is available and administered as an eye drop solution or ointment for the treatment of external bacterial eye infections in adults and children 2 months and older.

As an aminoglycoside antibiotic, Tobrex works to kill certain bacteria. Specifically, it works by blocking bacteria from making more proteins.

Tobrex contains the active ingredient tobramycin.

The tobramycin eye drop solution form of administration is available as brand-name Tobrex and is also available as generic tobramycin.

Other brand-name medications containing the active ingredient tobramycin, such as Tobrasol and AKTob, are also available as an ophthalmic (related to the eye) treatment. In comparison, the tobramycin ointment form of administration is currently only available as brand-name Tobrex.

This article will highlight the brand-name medication Tobrex in both ointment and eye drop solution form.

What Is Tobrex Used For?

Tobrex is used for bacterial eye infections.

Eye infections may come from various sources, such as viruses and fungi.

But worldwide, bacteria is the cause of numerous eye infections. And bacterial conjunctivitis is a common eye infection. In fact, 50 to 70% of conjunctivitis eye infections are due to bacteria.

While anyone can get bacterial conjunctivitis, this condition is more common in children and older adults.

Other risk factors may also include:

• Crowded conditions (environments)—like elementary schools
• Infrequent handwashing
• Long-term use of eye medications
• Other eye conditions
• Poor contact lens hygiene
• Recent eye surgery
• Use of old or contaminated makeup or makeup brushes
• Weakened immune system (body's defense system)

Symptoms may include:

• Burning, stinging, or irritating sensation—especially when trying to wear contact lenses
• Red eyes from inflamed (swollen) conjunctiva (the clear layer covering the white part of your eye)
• Sensitivity to lights
• Tearing and watery eyes
• Vision changes
  

How to Use Tobrex

Since directions may vary among eye medications, carefully read the directions and packaging label on your container. Keep the following in mind when using Tobrex solution eye drops or ointment:

• Don't touch the tip of the eye medication bottle or tube to your eye or any surface: This is to prevent injuring your eye or contaminating (dirtying) the eye medication.
• Wash your hands: Wash your hands before and after using eye drops or ointment.
• Wait between different eye products: You can typically wait five minutes between applying one and then another eye medication.
• Don't use Tobrex with contact lenses: Remove contact lenses from your eyes before using Tobrex. In general, don't wear contact lenses when you have an eye infection.

The following are steps to use the Tobrex solution eye drops that usually are applied every four to eight hours:

1. After washing your hands, tilt your head back to look up.
2. Pull down your lower eyelid to form a small cup or pocket.
3. Place one or two eye drops into this pocket.
4. Close your eyes and press down on your tear duct, which is the corner of your eye that's closest to your nose. Do this for at least one minute.
5. Tilt your head back up and repeat steps two through four for the other eye if your healthcare provider prescribed Tobrex for both eyes.
6. Use the Tobrex eye drops as frequently as your healthcare provider recommends. How often you use the eye drops may depend on the severity of your eye infection.

The following are some typical steps to use the Tobrex ointment, which is usually applied two to four times a day:

1. After washing your hands, place the ointment tube between your thumb and index (pointing) finger.
2. For the other fingers of the hand that's holding the ointment tube, place these fingers on your face to help stabilize the ointment tube as close to your eyelid as possible—without touching it.
3. Tilt your head to look up.
4. Using your pointing finger of the other hand, pull down your lower eyelid to form a small cup or pocket.
5. Squeeze a small amount (half-inch ribbon) of ointment into this pocket.
6. Gently blink your eye and close it for one to two minutes.
7. Place the ointment tube between your thumb and pointing finger. Then, repeat steps 2–6 for the other eye if your healthcare provider recommended placing Tobrex ointment in both eyes.
8. Use Tobrex ointment as frequently as your healthcare provider recommended. How often you use the ointment may depend on the severity of your eye infection.
   

Storage

Keep your medications tightly closed and out of the reach of children and pets, ideally locked in a cabinet or closet—and not in the bathroom.

Store at room temperature (68 to 77 degrees F).

Avoid pouring unused and expired drugs down the drain or in the toilet. Visit the FDA's website to learn where and how to discard all unused and expired drugs.

You can also find disposal boxes in your area. Ask your healthcare provider if you have any questions about the best ways to dispose of your medications.

If you travel with Tobrex, get familiar with your final destination's regulations. Checking with the U.S. Embassy or Consulate might be a helpful resource.

It's also a good idea to make a copy of your Tobrex prescription. And be sure to keep your medication in its original container from your pharmacy with your name on the label. Ask your healthcare provider if you have any questions about traveling with your medicine.

What Are the Side Effects of Tobrex?

This is not a complete list of side effects, and others may occur. A healthcare provider can advise you on side effects. If you experience other reactions, contact your pharmacist or healthcare provider. You may report side effects to the FDA at fda.gov/medwatch or 800-FDA-1088.

Common Side Effects

Common side effects of Tobrex include:

• Burning, itchy, or stinging sensation of the eyes
• Swollen eyes
• Tearing or watery eyes
  
• Temporary blurry vision from the ointment
  

Severe Side Effects

Get medical help right away if you develop the following serious side effects:

• Severe allergic reaction: If you have a severe allergic reaction to Tobrex, you may experience symptoms of facial swelling, itchiness, rash, and breathing difficulties that require emergency medical attention.
• Stevens-Johnson syndrome (SJS): SJS is a rare and severe condition that can become an emergency. Common symptoms of SJS may include peeling and blistering skin. The skin can feel very painful and raw.
• Erythema multiforme (EM): EM is a milder skin condition compared to SJS. Common symptoms of EM may include red, patchy, blistering, and itchy spots on the skin. These lesions may also appear on the lips and inside the mouth. Eye-related symptoms may include painful, dry, itchy, burning, or bloodshot eyes.
• Superinfection: In general, it's possible to experience another infection—like from fungi—on top of your current infection when using antibiotics.
• Delayed corneal healing: The cornea is the clear layer that's covering the iris (colored part of your eye) and the pupil (part of your eye where light enters). Your cornea may take longer to heal if you use ointments.

Call 911 if your symptoms feel life-threatening.

Long-Term Side Effects

In general, it's possible to experience another infection—like from fungi—on top of your current infection when using long-term antibiotics.

Contact your healthcare provider if you suspect that you're experiencing symptoms of another infection.

Dosage: How Much Tobrex Should I Use?

Modifications

The following modifications (changes) should be kept in mind when using Tobrex:

Severe allergic reaction: Avoid using Tobrex if you have a known allergy to tobramycin or any of Tobrex's ingredients. Ask your healthcare provider for a complete list of the ingredients if you're unsure.

Pregnancy: In three different animal studies, high doses of tobramycin given systemically didn't appear to have negative effects on fertility or the fetus. "Systemically" means that these doses were given either by mouth or by injection. This would allow for more widespread exposure to the drug than when just put into the eye.

While tobramycin was safe in these animal studies, not enough is known about the safety and effectiveness of Tobrex in pregnant people and on their unborn fetus.

Discuss with your healthcare provider if you plan to become pregnant or are pregnant. They will help you weigh the benefits and risks of Tobrex during your pregnancy.

Breastfeeding: It's unlikely for Tobrex eye medications to negatively affect nursing babies.

But you may talk with your healthcare provider if you plan to breastfeed. They will help you weigh the benefits and harms of Tobrex use while nursing. They can also discuss the different ways available to feed your baby.

Older adults over 65: Older and younger adults are unlikely to experience any differences in safety and effectiveness when using Tobrex.

But in general, older adults with other medical conditions or who are taking several medications should use caution with Tobrex. Older adults are typically more sensitive to side effects from medications.

Children: There is little safety and effectiveness information on Tobrex in infants under 2 months old.

People who wear contact lenses: Remove your contact lenses before applying Tobrex. In general, don't wear contact lenses when you have an eye infection.

Missed Dose

If you accidentally forget your Tobrex dose, use your eye medication as soon as you remember. If it's already close to your next scheduled dose, then skip the missed dose and take the following dose at your next scheduled dosing time. Don't try to double up to make up for the missed dose.

Try to find ways to help yourself remember to routinely keep your appointments and take your medication. If you miss too many doses, Tobrex might be less effective at treating your eye infection.

Overdose: What Happens If I Use Too Much Tobrex?

There is limited information available on overdoses and toxicity of Tobrex eye medications.

However, in the case of systemic versions—like Tobrex as an injection, the symptoms of a suspected overdose may include:

• Dizziness
• Ear problems, such as hearing loss and tinnitus (ringing in the ears)
• Less frequent urination
• Swelling in several body areas—like your face, arms, hands, lower legs, etc.

If you think that you're experiencing an overdose or life-threatening symptoms, seek immediate medical attention.

Precautions

What Are Reasons I Shouldn’t Use Tobrex?

Before using Tobrex, talk with your healthcare provider if any of the following applies to you:

Severe allergic reaction: If you have a severe allergic reaction to Tobrex or any of its ingredients, this medication isn't a viable option for you.

Pregnancy: While high doses of tobramycin seem safe in multiple animal studies, not enough is known about the safety and effectiveness of Tobrex in pregnant people and on their unborn fetus.

Breastfeeding: It's unlikely for tobramycin eye medications to negatively affect nursing babies.

Older adults over 65: Older and younger adults are unlikely to experience any safety and effectiveness differences when using Tobrex. But in general, older adults should use caution.

Children: There is little safety and effectiveness information on Tobrex in children under two months old.

What Other Medications Interact With Tobrex?

If you have multiple eye medications, don't use one immediately after another. The general recommendation is to wait five minutes between each eye medication.

For more detailed information about medication interactions with Tobrex, talk with your healthcare provider.

And be sure to talk with your healthcare provider about any other medicines you take or plan to take, including over-the-counter (OTC), nonprescription products, vitamins, herbs, or plant-based medicines.

What Medications Are Similar?

There are a number of antibiotic eye medications, but Tobrex is an aminoglycoside antibiotic. Another aminoglycoside antibiotic eye medication is gentamicin.

Both aminoglycosides are available as eye drops and ointment. And they are used to treat similar bacterial eye infections.

These antibiotic medications are comparable in terms of effectiveness and safety. They're also available in combination eye products with corticosteroids (steroids).

For severe eye infections, gentamicin ointment is not recommended for increased usage.

Generic tobramycin is only available in eye drops, whereas gentamicin has generic versions of both eye drops and ointment.

Since both tobramycin and gentamicin are aminoglycoside antibiotics, these eye medications aren't typically used together.

How Can I Stay Healthy While Using Tobrex?

If you're using Tobrex, chances are your eye infection has been negatively affecting your quality of life. Having an eye infection does have its challenges.

You may have tried different approaches or treatments. Refer below for some general tips to support your health and prevent future eye infections:

• Use eye medications as recommended by your healthcare provider.
• Wash your hands often.
• Try not to touch your eyes.
• Don't wear contact lenses when you have an eye infection.
• Properly clean your contact lenses.
• Don't share makeup and towels.
• Don't use old makeup and makeup brushes.