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Streptomycin

Streptomycin

General Information

  • Brucellosis
  • Chancroid
  • Granuloma inguinale
  • H. influenzae infection
  • Infection due to Mycobacterium tuberculosis
  • Infective endocarditis
  • Plague
  • Pneumonia
  • Sepsis due to gram-negative bacteria
  • Tularemia
  • Urinary tract infectious disease

Black Box Warning:

  • The risk of severe neurotoxic reactions is sharply increased in patients with impaired renal function or prerenal azotemia. The incidence of clinically detectable, irreversible vestibular damage is particularly high in patients treated with streptomycin.
  • Patients with renal impairment and/or nitrogen retention should receive reduced doses.
  • The neurotoxicity of streptomycin can result in respiratory paralysis from neuromuscular blockage, especially when the drug is given soon after the use of anesthesia or muscle relaxants.

Obtain serum creatinine renal function levels at baseline and monthly.

Monitor serum drug concentrations, particularly in patients with renal impairment or receiving hemodialysis, and potentially in patients receiving peritoneal dialysis.

Obtain acid-fast bacilli smear and culture until 2 consecutive culture specimens are negative.

Perform chest x-rays after 2 months of treatment.

Common

  • Rash
  • Fever
  • Paresthesia
  • Urticaria
  • Ototoxicity
  • Vestibular dysfuction

Serious

  • Erythroderma
  • Anaphylaxis
  • Nephrotoxicity
  • Respiratory tract paralysis - concomitant anesthesia, muscle relaxants

Contraindications:

  • Ataluren- may result in decrased activity and increased risk of nephrotoxicity

Major drug-drug interactions:

  • Ethacrynic acid
  • Nondepolarizing neuromuscular blockers
  • Colistimethate sodium
  • Lysine
  • Succinylcholine
  • Furosemide
  • Cidofovir
  • Ascorbic acid
  • Foscarnet

Avoid concurrent or sequential use:

  • Neomycin
  • Kanamycin
  • Gentamicin
  • Cephaloridine
  • Paromomycin
  • Viomycin
  • Polymyxin B
  • Colistin
  • Tobramycin
  • Cyclosporine

Antimicrobial class: Aminoglycoside, Antitubercular

Pregnancy category: D

Average serum half life: 5-6 hours

Precautions:

  • Use extreme caution in patients with renal insufficiency as a single dose in severely uremic patients may produce ototoxic sequelae; dose adjustment required.
  • Urine alkalinization may minimize or prevent renal irritation when prolonged therapy is necessary.
  • Vestibular and auditory dysfunction may occur; increased risk with higher dosage, longer treatment duration, renal insufficiency, underlying existing auditory dysfunction, and coadministration of ethacrynic acid, mannitol, furosemide and other diuretics; monitoring recommended and early discontinuation may be necessary.
  • Monitoring recommended in infants.