Explanation

Tobramycin (also called Bramitob or TOBI) as a nebuliser solution is used to treat long-term lung infections that you can get if you have cystic fibrosis. You can only have this medicine if you are aged over 6 years.

Tobramycin is a type of medicine called an anti-bacterial.

What does tobramycin do?

Tobramycin nebuliser solution helps to get rid of chest infections you can get if you have cystic fibrosis, so that you can breathe more easily.

What does it look like?

Tobramycin as a nebuliser solution is a yellowish liquid that comes in separate containers for each time you use it. Sometimes the colour of the liquid may be slightly different in the different containers, but this doesn't matter as long as you have been keeping them in the fridge and out of light.

When do I have to take it?

You should use your nebuliser to breathe in the liquid over about 15 minutes, twice a day - once in the morning and once in the evening. You should try to leave 12 hours between each dose, and take it at the same time in the morning and at night.

You will take your tobramycin in treatment cycles. This means you will take it for a set number of days (most likely 28) and then have a break (probably for 28 days) before you then take it again for a set number of days - the next 'cycle'.

You should keep repeating these treatment cycles until your doctor says you can stop. You may want to use a calendar and get your parents or the adult looking after you to help you keep track of your treatment cycles.

But what if I don't feel like taking it?

It's important that you keep taking tobramycin nebuliser solution twice a day, every day, even if you don't want to, and even if you start feeling better, until your doctor says you can stop. If you don't, the infection in your lungs will come back and make it harder for you to breathe.

If you don't take tobramycin nebuliser solution for all of the treatment cycle, some of the bacteria that caused the infection may still be in your lungs. These will start dividing and making more and more bacteria that will be harder to get rid of next time round.

What should I do if I forget to take it?

If you forget to take tobramycin nebuliser solution, you should just take it when you remember (if it's not long after you should have taken it) or take the next dose at the usual time.

Make sure you do not take a double dose to make up for the dose you missed. Remember the three Ds: Don't Double Dose!

How much should I take?

Tobramycin nebuliser solution comes in separate containers, one for each dose, so it's already measured out for you. You will need to inhale the liquid from one container in the morning and another container in the evening, so twice a day (during the days in your treatment cycle that you should be taking it), unless your doctor tells you not to.

What are the most likely side effects I might get?

The side effects you are most likely to get with using tobramycin nebuliser solution are:

thick white or cream-coloured spots in your mouth

shortness of breath, a cough or changes to your voice

nausea (feeling sick)

producing lots of saliva (spit)

a rash on your skin

worsened cough

Don't forget to let your doctor know if you notice any of these side effects while you are on tobramycin nebuliser solution.

What other side effects might I get?

There are other side effects that you may get with tobramycin nebuliser solution, but it is very unlikely. It's important you keep a look out for them though, and make sure you tell your doctor if you notice any of these:

swollen lymph nodes

feeling dizzy or getting headaches

feeling sleepy

ringing in your ears or loss of hearing

sore ears

diarrhoea (runny poo)

sore back

Is it safe for me to be taking it?

Before you start taking tobramycin nebuliser solution, you need to tell your doctor if you know you are allergic to tobramycin. The first time you try tobramycin nebuliser solution a doctor or nurse should be there with you to make sure it is ok for you to take.

It's important that you tell your doctor if you have problems with your kidneys, hearing or balance. You must also let him or her know if you have any problems with your muscles or controlling movement (neuromuscular disorders).

Is it okay for me to take it if I am already taking other medicines?

Before you start taking tobramycin nebuliser solution, it's important to tell your doctor if you're taking any other medicines, including herbal medicines or any that you have bought from a pharmacist without a prescription.

It's especially important to tell your doctor if you're taking any of the following:

a type of antibiotic called aminoglycosides, for example gentamicin and streptomycin

any other medicines you inhale

diuretic like furosemide, ethacrynic acid, urea or mannitol

Drugs to stop rejection if you have had an organ transplant, like cyclosporin or tacrolimus, for example

Is there anything else I need to know about tobramycin?

You should always make sure your tobramycin nebuliser solution is kept in the fridge. It needs to be stored in the dark and at a low temperature for it to work properly.

What if I have any more questions?

If you have any other questions, you can ask your doctor, or chat to other people with cystic fibrosis in the Medikidz forums and virtual world, Mediland.