毒理性
◉ 母乳喂养期间使用概述：妥布霉素在母乳中的排泄量很少。新生儿显然会吸收少量其他氨基糖苷类药物，但在典型的每日三次剂量下，血清水平远低于治疗新生儿感染时达到的水平，因此妥布霉素的系统影响不太可能发生。年龄较大的婴儿吸收的妥布霉素会更少。由于在多次每日剂量方案中，母乳中妥布霉素水平的变异性很小，因此在与剂量相关的哺乳时机上减少婴儿暴露几乎没有或没有好处。对于单日剂量方案，尚无数据。监测婴儿可能出现的影响胃肠道菌群的情况，如腹泻、念珠菌病（例如，鹅口疮、尿布疹）或罕见的情况下，粪便中出现血液，提示可能存在抗生素相关性结肠炎。
母亲使用含有妥布霉素的耳滴或眼滴对哺乳婴儿几乎没有或没有风险。一个由欧洲、澳大利亚和新西兰的呼吸专家组成的小组发现，吸入妥布霉素与哺乳是相容的。
◉ 对哺乳婴儿的影响：一名婴儿在产后第4个月之前一直母乳喂养（喂养程度未说明）。在2个月大时，他的母亲因囊性纤维化加重而接受了为期2周的妥布霉素150毫克，每日三次加美罗培南的治疗。在母亲治疗期间，婴儿的大便模式没有变化，在6个月大时肾功能正常。
◉ 对泌乳和母乳的影响：截至修订日期，未找到相关的已发布信息。
◉ Summary of Use during Lactation:Tobramycin is poorly excreted into breastmilk. Newborn infants apparently absorb small amounts of other aminoglycosides, but serum levels with typical three times per day dosages are far below those attained when treating newborn infections and systemic effects of tobramycin are unlikely. Older infants would be expected to absorb even less tobramycin. Because there is little variability in the milk tobramycin levels during multiple daily dose regimens, timing breastfeeding with respect to the dose is of little or no benefit in reducing infant exposure. Data are not available with single daily dose regimens. Monitor the infant for possible effects on the gastrointestinal flora, such as diarrhea, candidiasis (e.g., thrush, diaper rash) or rarely, blood in the stool indicating possible antibiotic-associated colitis.
Maternal use of an ear drop or eye drop that contains tobramycin presents little or no risk for the nursing infant. A task force respiratory experts from Europe, Australia and New Zealand found that inhaled tobramycin is compatible with breastfeeding.
◉ Effects in Breastfed Infants:An infant was breastfed (extent not stated) until the 4th month postpartum. At 2 months of age, his mother was given a 2-week course of tobramycin 150 mg three times daily plus meropenem for a cystic fibrosis exacerbation. infant displayed no change in stool pattern during the maternal treatment and had normal renal function at 6 months of age.
◉ Effects on Lactation and Breastmilk:Relevant published information was not found as of the revision date.
来源:Drugs and Lactation Database (LactMed)
