Streptomycin

Last Updated June 10, 2016

Trade Names

Bio-Strep

Drug Classification

Aminoglycoside bacteriocidal antibiotic

Formulations

1 g/3 mL solution for injection

Indications and Pharmacology

Indication: treatment of primary tuberculosis in combination with other antituberculosis drugs; also infections caused by many Gram-negative bacteria (excluding Pseudomonas aeruginosa).

Mechanism of action: inhibition of protein synthesis through binding 30S ribosomal unit, causing cell death.

Pharmacokinetics: widely distributed throughout body; half-life 2-3 hours (may be longer with renal impairment).

Dosage

Adult Dose: 12-18 mg/kg/day, maximum 1 g/day (maximum 500-750 mg/day in elderly).

Use in Renal or Hepatic Insufficiency:

• Renal impairment: Increase dose intervals; glomerular filtration rate 10-50 mL/min: 24-72 hours; glomerular filtration rate < 10 mL/min, 72-96 hours.
• No adjustment needed in hepatic impairment.

Use in Pregnancy and Breastfeeding*: Pregnancy Category D. Known to cross placenta and may cause foetal ototoxicity.

May be safe for nursing infants due to poor oral absorption.

Use in Children: 15-20 mg/kg/day, maximum 1 g/day.

Warnings

Contraindicated in patients with hypersensitivity to streptomycin or other aminoglycosides.*

Can cause vestibular toxicity (heralded by headache, nausea, vomiting, disequilibrium) and cochlear toxicity (heralded by loss of high-frequency hearing); patients should be monitored to avoid irreversible damage.*

Increased risk of severe neurotoxic reactions, including ototoxicity, optic nerve dysfunction, and peripheral neuritis, in patients with renal impairment or prerenal azotaemia.*

Should be used with caution in patients with renal failure, hearing or vestibular impairment.*

Respiratory paralysis due to neuromuscular blockade may occur, especially when used soon after anaesthesia or muscle relaxants.*

Drug–Drug Interactions

Ototoxicity and nephrotoxicity potentiated by other ototoxic or nephrotoxic agents.

Neuromuscular blockade potentiated by general anaesthetics or neuromuscular-blocking agents.

Considerations for Special Populations

Geriatric: may require reduced dose due to renal impairment; increased susceptibility to vestibular toxicity effects.

Paediatric: daily injection required; may be indicated in children with contraindications to standard drug regimens.

Renal impairment/prerenal azotaemia: increased risk of severe neurotoxic reactions, including ototoxicity, optic nerve dysfunction, and peripheral neuritis.

Use with caution in patients with renal failure, hearing or vestibular impairment.

Adverse Effects

Ototoxicity (vestibular more common than cochlear), paresthesia of face, rash, fever, urticaria, angioneurotic oedema, eosinophilia, exfoliative dermatitis, anaphylaxis, azotaemia, leucopenia, thrombocytopenia, pancytopenia, haemolytic anaemia, muscular weakness, amblyopia, nephrotoxicity, hypersensitivity reactions.*

*Information from US prescribing information.