Tobramycin Vancomycin — Compare Prices at US & Canada Pharmacies

Tobramycin-vancomycin is a compounded "fortified" ophthalmic antibiotic — not a commercially FDA-approved eye drop, but a custom-prepared combination made by a compounding pharmacy (here, Imprimis/Harrow) at much higher concentrations than standard eye drops, specifically for severe bacterial corneal infections (bacterial keratitis or corneal ulcers) that need aggressive, broad-spectrum treatment right away. Pairing an aminoglycoside (tobramycin, covering Gram-negative organisms including Pseudomonas aeruginosa) with a glycopeptide (vancomycin, covering resistant Gram-positive organisms including MRSA) gives ophthalmologists broad coverage while awaiting culture results in an infection that can threaten vision if treatment is inadequate.

Because it's compounded rather than manufactured under standard FDA drug approval, formulation strength, stability, and quality can vary between compounding pharmacies, which is part of why ophthalmologists specify the exact concentration and source when prescribing it. These fortified drops are typically dosed very frequently at first — sometimes hourly, including overnight, during the acute phase of a severe corneal infection — a dosing intensity far beyond routine antibiotic eye drops, reflecting how aggressively bacterial keratitis needs to be treated to prevent permanent corneal scarring or vision loss.

Because tobramycin at these concentrations is still absorbed to some degree, and both components carry allergy potential, patients are monitored for local irritation, and any worsening redness, pain, or vision change during treatment is treated as urgent rather than assumed to be a normal part of healing. This combination is a specialist, hospital- or ophthalmology-clinic-driven treatment rather than something used for routine, mild eye infections.

Boxed warning

BOXED WARNINGS Patients treated with aminoglycosides should be under close clinical observation because of the potential toxicity associated with their use. As with other aminoglycosides, gentamicin injection is potentially nephrotoxic. The risk of nephrotoxicity is greater in patients with impaired renal function and in those who receive high dosage of prolonged therapy. Neurotoxicity manifested by ototoxicity, both vestibular and auditory, can occur in patients treated with gentamicin, primarily in those with pre-existing renal damage and in patients with normal renal function treated with higher doses and/or for longer periods than recommended.

Contraindications

CONTRAINDICATIONS: Hypersensitivity to gentamicin is a contraindication to its use. A history of hypersensitivity or serious toxic reactions to other aminoglycosides may contraindicate use of gentamicin because of the known cross-sensitivity of patients to drugs in this class.

Warnings

WARNINGS: (See BOXED WARNINGS .) Contains sodium metabisulfite, a sulfite that may cause allergic-type reactions including anaphylactic symptoms and life-threatening or less severe asthmatic episodes in certain susceptible people. The overall prevalence of sulfite sensitivity in the general population is unknown and probably low. Sulfite sensitivity is seen more frequently in asthmatic than in non-asthmatic people. Aminoglycosides can cause fetal harm when administered to a pregnant woman. Aminoglycoside antibiotics cross the placenta, and there have been several reports of total irreversible bilateral congenital deafness in children whose mothers received streptomycin during pregnancy.