Treatment with Brahitibom should appoint a doctor who has experience in managing patients with cystic fibrosis. The duration of the course treatment is determined by the doctor, based on the clinical picture of the disease. In case of confirmed impairment of pulmonary function, additional antibiotic therapy should be prescribed.
When inhaled, BRAMITOB can develop bronchospasm. The first dose of BRAMITOB should be administered under the supervision of a doctor, appointing a bronchodilator before inhalation, if it is already part of the patient's treatment regimen. Before and after the procedure, measure FEV1 (volume of forced expiration). When there are signs of iatrogenic bronchospasm in a patient who does not receive a bronchodilator, the use of the drug should be repeated separately, using a bronchodilator. The appearance of bronchospasm on the background of the use of a bronchodilator may indicate an allergic reaction. If you suspect a allergic reaction, use of BRAMITOB should be discontinued.For relief of bronchospasm should be appropriate pathogenetic therapy.
During treatment with Brahitobom, the patient should continue with standard chest physiotherapy. The use of bronchodilators should continue according to clinical indications. When using several methods of treatment of respiratory disorders, the following order is recommended: bronchodilator, respiratory physiotherapy, other inhaled medications and in the end - Bramitob.
Bramitob should not be mixed with other inhaled medications.
Braamytob should be used with great caution in patients with Parkinsonism or other conditions characterized by muscle weakness, including myasthenia gravis, since aminoglycosides can exacerbate muscle weakness due to a possible curare-like effect on neuromuscular conductivity.
The drug should be used with caution in patients with proven or suspected renal failure, provided monitoring of tobramycin concentrations in serum.
It is necessary to periodically assess the indicators of kidney function (the level of urea and creatinine at least once during 6 courses of therapy with Brahitibom.When signs of nephrotoxicity appear, treatment with tobramycin should be discontinued until the minimum serum concentrations in the serum are reduced to less than 2 μg / ml. Then, treatment with BRAMITBOM can be resumed for medical reasons. Patients simultaneously receiving parenteral therapy with other aminoglycosides should be carefully monitored because of the possibility of developing cumulative toxicity.
When using aminoglycosides, it is possible to develop ototoxicity (hypoacusia, systemic and non-systemic dizziness, ataxia).
The physician should consider the possibility that aminoglycosides may have vestibular and cochlear toxicity and, in the course of therapy, BRAMITIBOM should evaluate the function of the hearing. Patients who have previously received aminoglycosides for a long time are advised to undergo audiometric tests prior to the initiation of therapy with BRAMITBOM. In the treatment of vertigo, it should be taken into account that it is a manifestation of ototoxicity. If there is dizziness or hearing loss during therapy with Brahitybom, an audiological examination is necessary.
When inhaled, a cough reflex may appear.The use of inhaled tobramycin in patients with acute hemoptysis should only be carried out if the benefit of treatment exceeds the risk of provoking further bleeding.
In some patients who received
tobramycin, there is an increase in the MIC of aminoglycosides with respect to the studied isolated strains
R. aeruginosa. Possible development of resistance of strains of P. aeruginosa, to intravenously injected tobramycin.