Would you recommend avoiding intravesical (bladder) tobramycin administration in a patient with advanced chronic kidney disease?  

Guess fear is absorption , build up and toxicity. Single loading dose of an aminoglycoside is not to toxic level. Mainting level risks ototoxicity, build up also nephrotoxicity. Would depend on absorption and residual GFR. Try single loading dose check levels may be 12 , 24 hours to get an id...