Streptomycin: Uses, Dosage, Side Effects and More

This information is not country-specific. Please refer to the Malaysia prescribing information.

Generic Medicine Info

Indications and Dosage

Intramuscular
Tularaemia

Adult: 1-2 g daily in divided doses for 7-14 days until the patient is afebrile for 5-7 days.
Child: 15 mg/kg bid for at least 10-14 days. Max: 2 g daily.

Intramuscular
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 an additional 4 wk. Doses are given in combination w/ penicillin.
Elderly: Streptococcal endocarditis: >60 yr 500 mg bid for the entire 2 wk period.
Child: Enterococcal endocarditis: 20-30 mg/kg daily in 2 divided doses, in combination w/ penicillin.

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.
Elderly: >40 yr Max: 500-750 mg daily.
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.

Intramuscular
Plague

Adult: 2 g daily in 2 divided doses for a minimum of 10 days.
Child: 30 mg/kg daily in 2-3 divided doses. Max: 2 g daily.

Intramuscular
Bacteraemia, Brucellosis, Meningitis, Pneumonia, 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 g daily.
Child: 20-40 mg/kg daily in divided doses 6-12 hrly.

What are the brands available for Streptomycin in Malaysia?

Streptomycin Sulfate KAPL

Renal Impairment

Dosage adjustment needed.

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.

Contraindications

Hypersensitivity to streptomycin and other aminoglycosides.

Special Precautions

Patient w/ neuromuscular disorders (e.g. myasthenia gravis), pre-existing vertigo, or hearing loss. Renal impairment. Elderly, childn. Pregnancy and lactation.

Adverse Reactions

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.

Pregnancy Category (US FDA)

IM/IV/Parenteral: Z (Associated with increased risk of maternal and neonatal ototoxicity. Generally contraindicated. Consult product literature and clinical guidelines for specific recommendations.)

Monitoring Parameters

Monitor renal and auditory function.

Drug Interactions

Additive neurotoxic and nephrotoxic effect w/ neomycin, kanamycin, gentamicin, cefaloridine, paronomycin, viomycin, polymyxin B, colistin, tobramycin, and ciclosporin. Enhanced ototoxic and nephrotoxic effect w/ ethacrynic acid, mannitol, furosemide and possibly other diuretics. May enhance the resp depressant effect of neuromuscular blockers. Increased risk of nephrotoxicity w/ cephalosporins. Reduced excretion w/ NSAIDs.

Action

Description:
Mechanism of Action: Streptomycin inhibits bacterial protein synthesis by binding directly to the 30S ribosomal subunits causing faulty peptide sequence to form in the protein chain.
Pharmacokinetics:
Absorption: Not absorbed from the GI tract. Rapidly absorbed (IM). Time to peak plasma concentration: 0.5-2 hr.
Distribution: Rapidly distributed into most body tissues and fluids except the brain. Crosses the placenta and enters breast milk. Plasma protein binding: Approx ¹/₃ of the drug in circulation.
Excretion: Via urine, approx 30-90% as unchanged drug. Half-life: Approx 2.5 hr.

Chemical Structure

Storage

Store between 15-30°C. Protect from light.

MIMS Class

Aminoglycosides / Anti-TB Agents

References

Anon. Streptomycin. Lexicomp Online. Hudson, Ohio. Wolters Kluwer Clinical Drug Information, Inc. https://online.lexi.com. Accessed 22/10/2014.

Buckingham R (ed). Streptomycin. Martindale: The Complete Drug Reference [online]. London. Pharmaceutical Press. https://www.medicinescomplete.com. Accessed 22/10/2014.

McEvoy GK, Snow EK, Miller J et al (eds). Streptomycin Sulfate. AHFS Drug Information (AHFS DI) [online]. American Society of Health-System Pharmacists (ASHP). https://www.medicinescomplete.com. Accessed 22/10/2014.

Streptomycin Sulfate Injection, Powder, Lyophilized, for Solution. DailyMed. Source: U.S. National Library of Medicine. https://dailymed.nlm.nih.gov/dailymed/. Accessed 22/10/2014.

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