Provider Briefing: Tobrex Supply Disruptions in 2026

Tobramycin ophthalmic (brand name Tobrex) has been subject to intermittent supply disruptions that continue to affect patient access in 2026. For ophthalmologists, optometrists, primary care physicians, and urgent care providers who prescribe this medication, understanding the current landscape is essential for ensuring continuity of care.

This article provides a clinical overview of the shortage, its implications for prescribing, available alternatives, and tools to help your patients access the medications they need.

Shortage Timeline

Supply issues with sterile ophthalmic products, including Tobramycin, began escalating around 2020 and have persisted with varying intensity:

• 2020-2021: Initial disruptions linked to pandemic-related supply chain challenges and increased demand for sterile products.
• 2022-2023: Manufacturing consolidation in the sterile ophthalmic space led to capacity constraints. FDA enforcement actions at key sterile manufacturing facilities reduced production output.
• 2024: Several generic manufacturers experienced production delays. Brand-name Tobrex availability became particularly inconsistent.
• 2025-2026: Gradual improvement as new generic approvals and facility remediations increase capacity, but supply remains inconsistent in many markets.

The FDA Drug Shortages database has listed Tobramycin ophthalmic intermittently during this period. Even when not formally listed, localized shortages continue to be reported by pharmacies and patients.

Prescribing Implications

The shortage has several practical implications for prescribers:

Generic Substitution

Unless clinical circumstances require brand-name Tobrex specifically, prescribing generic Tobramycin ophthalmic or allowing generic substitution (avoiding "Dispense as Written" designations) significantly improves the likelihood of successful dispensing. Multiple generic manufacturers produce Tobramycin 0.3% ophthalmic solution and ointment.

Formulation Flexibility

When Tobramycin solution is unavailable, the ointment formulation (0.3%) may be in stock. While ointment causes transient visual blurring and is less convenient for daytime use, it provides the same antimicrobial coverage and can serve as an appropriate alternative for many indications, particularly for bedtime dosing or when treating blepharitis.

Therapeutic Alternatives

When Tobramycin is unavailable in any form, consider the following evidence-based alternatives:

• Ciprofloxacin ophthalmic 0.3% (Ciloxan): Broad-spectrum fluoroquinolone with comparable gram-negative coverage. Available as drops and ointment. Well-established generic availability. May cause white crystalline precipitate on the cornea (generally resolves spontaneously).
• Moxifloxacin ophthalmic 0.5% (Vigamox): Fourth-generation fluoroquinolone with excellent broad-spectrum coverage including enhanced gram-positive activity. Self-preserved (no BAK). Convenient TID dosing. Generic now available, though brand remains expensive.
• Polymyxin B/Trimethoprim ophthalmic (Polytrim): Effective combination for bacterial conjunctivitis. Widely available, inexpensive generic. Less appropriate for severe infections, keratitis, or corneal ulcers.
• Erythromycin ophthalmic ointment 0.5%: Macrolide with primarily gram-positive coverage. Very affordable. Best suited for mild infections or when an ointment formulation is preferred. Limited gram-negative spectrum compared to Tobramycin.

For more detail on these alternatives, see our patient-facing alternatives guide, which you can also share with patients.

Current Availability Picture

Availability varies significantly by region and pharmacy type:

• Chain pharmacies: Most affected due to centralized distribution. Stock levels fluctuate with wholesaler allocations.
• Independent pharmacies: Often have access to multiple wholesalers, providing more sourcing flexibility.
• Hospital outpatient pharmacies: May maintain separate supply chains with more consistent access to ophthalmic antibiotics.
• Compounding pharmacies: Can prepare Tobramycin ophthalmic solutions when commercial products are unavailable, though this requires appropriate sterile compounding capabilities (USP <797> compliance).

The availability gap between brand-name Tobrex and generic Tobramycin is significant. Generic products are substantially more available in most markets.

Cost and Access Considerations

Cost can be a barrier to patient compliance, particularly if they're directed to brand-name Tobrex when generic is unavailable:

• Brand-name Tobrex: $80-$200 (cash price, 5 mL)
• Generic Tobramycin ophthalmic: $15-$45 (cash price, 5 mL)
• With insurance: Generic typically Tier 1-2 with $5-$25 copays
• Discount programs: GoodRx, SingleCare, and similar programs can reduce generic costs to $10-$20

For patients facing cost barriers, our savings guide for Tobrex provides comprehensive information on discount programs and patient assistance.

Tools and Resources for Your Practice

Several resources can help you and your staff manage the impact of this shortage:

Medfinder for Providers

Medfinder offers real-time pharmacy availability data that your staff can use to direct patients to pharmacies with Tobramycin in stock. Rather than sending patients out with a prescription and hoping for the best, a quick check can identify available pharmacies before the patient leaves your office.

FDA Drug Shortages Database

The FDA maintains an updated list of current drug shortages at accessdata.fda.gov. Monitoring this resource helps you stay ahead of availability changes and proactively adjust prescribing patterns.

ASHP Drug Shortage Resources

The American Society of Health-System Pharmacists (ASHP) provides shortage information and clinical guidance that can support formulary decisions and therapeutic substitution protocols.

Patient Education Materials

Directing patients to reliable information helps manage expectations and empowers them to take action. Our blog articles provide patient-friendly guidance:

• How to find Tobrex in stock
• Alternatives to Tobrex
• What is Tobrex: uses, dosage, what you need to know

Looking Ahead

The sterile ophthalmic manufacturing landscape is gradually improving. Key developments to watch:

• New generic approvals: The FDA has prioritized generic approvals for shortage-affected products, which should add manufacturing capacity over time.
• Facility remediations: Several sterile manufacturing facilities are completing remediation work that should restore production capacity.
• Supply chain diversification: Industry and regulatory efforts to diversify API sourcing and finished product manufacturing should reduce vulnerability to single-point failures.

However, the sterile ophthalmic space will likely remain somewhat supply-constrained through 2026, and providers should continue to maintain familiarity with therapeutic alternatives.

Final Thoughts

The Tobramycin ophthalmic shortage requires a proactive approach: prescribe generically when possible, maintain familiarity with therapeutic alternatives, and leverage availability tools to direct patients to pharmacies with stock. By integrating these strategies into your workflow, you can minimize the impact on patient care.

Visit Medfinder for Providers to access real-time availability data and help your patients find the medications they need. For a practical guide on integrating these tools into your practice, see our article on how to help your patients find Tobrex in stock.