Streptomycin
Indications
Streptomycin is used for:
Tuberculosis, Bacterial endocarditis, Plague, Tularaemia, Brucellosis
Adult Dose
Intramuscular
Tuberculosis
Adult: 15 mg/kg as a single dose daily. Max: 1 g daily. As part of intermittent regimen: 25-30 mg/kg 2-3 times wkly. Max: 1.5 g/dose.
Bacterial endocarditis
Adult: Streptococcal endocarditis: 1 g bid for 1 wk, then 500 mg bid for the 2nd wk. Enterococcal endocarditis: 1 g bid for 2 wk then 500 mg bid for 4 wk. Doses are given in combination w/ penicillin.
Bacteraemia; Meningitis; Pneumonia ; Brucellosis; Urinary tract infections
Adult: For concomitant use w/ other agents and as 2nd line agent: 1-2 g daily in divided doses 6-12 hrly. Max: 2 daily.
Plague
Adult: 2 g daily in 2 divided doses for a minimum of 10 days.
Tularaemia
Adult: 1-2 g daily in divided doses for 7-14 days until the patient is afebrile for 5-7 days.
Child Dose
Child:
Moderate to Severe Infections: IM usually 20–30 mg/kg/day, max 1 g/day q12h
Intramuscular
Tuberculosis
Child: 20-40 mg/kg as a single dose daily. Max: 1 g daily. As part of intermittent regimen: 25-30 mg/kg 2-3 times wkly. Max: 1.5 g/dose.
Bacterial endocarditis
Child: Enterococcal endocarditis: 20-30 mg/kg daily in 2 divided doses, in combination w/ penicillin.
Bacteraemia; Meningitis; Pneumonia ; Brucellosis; Urinary tract infections
Child: 20-40 mg/kg daily in divided doses 6-12 hrly.
Plague
Child: 30 mg/kg daily in 2-3 divided doses. Max: 2 g daily.
Tularaemia
Child: 15 mg/kg bid for at least 10-14 days. Max: 2 g daily.
Renal Dose
Renal Impairment
Load: 1 g IM, THEN
CrCl: 50-80 mL/min: 7.5 mg/kg IM q24hr
CrCl: 10-50 mL/min: 7.5 mg/kg IM q24-72hr
CrCl <10 mL/min: 7.5 mg/kg IM q72-96hr
Hemodialysis: 50-75% of initial loading dose at end of dialysis period
Administration
Reconstitution: Add 4.2 mL, 3.2 mL, or 1.8 mL of sterile water for inj to prepare a soln containing approx 200 mg, 250 mg, or 400 mg, respectively, of streptomycin per mL.
Contra Indications
Hypersensitivity to streptomycin and other aminoglycosides.
Precautions
Patient w/ neuromuscular disorders (e.g. myasthenia gravis), pre-existing vertigo, or hearing loss. Renal impairment. Elderly, childn. Pregnancy and lactation. Monitoring Parameters Monitor renal and auditory function.
Pregnancy-Lactation
Pregnancy Category: D
Lactation: enters breast milk (AAP Committee states compatible w/ nursing)
Interactions
H1-receptor blockers may mask early signs of ototoxicity. May reduce excretion of zalcitabine. May inhibit ?-galactosidase activity.
Potentially Fatal: Potentiates nephrotoxicity produced by other aminoglycosides, vancomycin and some cephalosporins. Potentiates ototoxicity produced by other aminoglycosides, ethacrynic acid, mannitol, furosemide and other diuretics.
Adverse Effects
Side effects of Streptomycin :
Neurotoxic reactions (e.g. vestibular and cochlear function disturbance, optic nerve dysfunction, peripheral neuritis, arachnoiditis, encephalopathy); paraesthesia of face, rash, fever, angioneurotic oedema, eosinophilia; exfoliative dermatitis, azotemia, leucopenia, thrombocytopenia, pancytopenia, haemolytic anaemia, muscular weakness, amblyopia.
Potentially Fatal: Resp paralysis from neuromuscular blockade, Clostridium difficile-associated diarrhoea, anaphylaxis; rarely, nephrotoxicity.
Mechanism of Action
Streptomycin is bactericidal which inhibits bacterial protein synthesis. Susceptible organisms include Mycobacterium tuberculosis, Pasteurella pestis, P.tularensis, Brucella, H.influenzae, H.ducreyi, Klebsiella pneumonia, Escherichia coli, Proteus spp., Aerobacter aerogenes, Streptococcus faecalis, and Streptococcus viridans.