Streptomycin

Category:

  • Antibiotic

Description:

  • Aminoglycoside antibiotic

Indications:

  • Mycobacterium tuberculosis

  • Nontuberculosis infections:

    • Pasteurella pestis (plague)

    • Francistularensis (tularemia)

    • Brucella

    • Calymmatobacterium granulomatis

    • Haemophilus ducreyi (chancroid)

    • H. influenzae, K. pneumoniae, E. coli, Proteus species, A. aerogenes, K. pneumoniae, Enterococcus faecalis, S. viridans)

  • Unlabeled uses:

    • Mycobacterium avium complex

Contraindications:

  • Generally not indicated for long-term therapy due to nephrotoxocity and ototoxicity

Precautions:

  • Pregnancy category D

  • May cause nephrotoxicity, therefore closely monitor renal function, especially in elderly patients.

  • May cause ototoxicity, therefore monitor hearing

  • Monitor peak and trough serum concentrations

  • In patients with extensive burns, altered pharmacokinetics may alter serum concentrations.

  • May produce hypomagnesemia, especially if poor or restricted diet.

  • Aminoglycosides have neuromuscular blockade activity with a curare-like effect.  Monitor patientís neuromuscular function, especially in patients with myasthenia gravis, parkinsonism or infant botulism.

Adverse Reactions (Side Effects):

  • Central and peripheral nervous system reactions: lethargy, neuromuscular blockade, facial neurotoxicity, peripheral parasthesia, muscular weakness

  • Gastrointestinal: vomiting, nausea

  • Hematologic: altered WBC counts

  • Hypersensitivity: rash, urticaria, itching

  • Special senses: vertigo, hearing loss

  • Renal: azotemia

  • Pain at injection site

Dosage:

  • Administered by IM injection

  • Adults:

    • normal renal function: 1-2 grams in divided doses q6-12h (not to exceed 2 grams per day)

  • Children:

    • 20-40mg/kg/day in divided doses q6-12h

  • Tuberculosis (administered by single IM injection):

    • Adults: 15mg/kg/day or 25-30mg/kg twice a week  or 25-30mg three times weekly

    • Children: 20-40mg/kg/day or 25-30mg/kg twice a week  or 25-30mg three times weekly

  • Tularemia: 

    • 1-2 grams per day in divided doses for 7-14 days (or until 5 days afebrile)

  • Plague: 

    • 2 grams daily in two divided doses for minimum of 10 days

  • Bacterial endocarditis (streptococcal): 

    • 1 gram bid for first week, 500mg bid for second week (given with a penicillin)

  • Bacterial endocarditis (enterococcal): 

    • 1 gram tid for 2 weeks, then 500mg bid for 4 weeks (given with a penicillin)

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