streptomycin

REMS

Active tuberculosis (in combination with other agents).
Serious enterococcal or gram-negative infections (in combination with other agents).

Contraind./Precautions

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Contraindicated in:

Hypersensitivity;
Cross-sensitivity among aminoglycosides may occur.

Use Cautiously in:

Renal impairment (dosage adjustments necessary; plasma concentrations monitoring useful in preventing ototoxicity and nephrotoxicity);
Hearing impairment;
Mitochondrial DNA variants in the 12S rRNA gene (MTRNR1) or maternal history of ototoxicity (↑ risk of ototoxicity);
Neuromuscular diseases such as myasthenia gravis;
Obese patients (dosage should be based on ideal body weight);
OB: May ↑ risk of congenital deafness when used during pregnancy;
Lactation: Safety not established in breastfeeding;
Geri: ↑risk of ototoxicity and nephrotoxicity in older adults.

Adv. Reactions/Side Effects

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EENT: ototoxicity (vestibular and cochlear)

F and E: hypomagnesemia

GU: nephrotoxicity

MS: muscle paralysis (high parenteral doses)

Misc: hypersensitivity reactions

Interactions

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Drug-drug:

Inactivated by penicillins and cephalosporins when coadministered to patients with renal impairment.
Possible respiratory paralysis after inhalation anesthetics orneuromuscular blockers.
↑risk of ototoxicity withloop diuretics.
↑risk of nephrotoxicity with othernephrotoxic drugs.

Availability

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(Generic available)

Lyophilized powder for injection: 1 g/vial
Solution for injection: 500 mg/mL

Route/Dosage

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IM (Adults ): Tuberculosis: 1 g/day initially, decreased to 1 g 2–3 times weekly;other infections: 250 mg–1 g every 6 hr or 500 mg–2 g every 12 hr.
IM (Children ): Tuberculosis: 20 mg/kg/day (not to exceed 1 g/day);other infections: 5–10 mg/kg every 6 hr or 10–20 mg/kg every 12 hr.

Renal Impairment

IM (Adults ): 1 g initially; further dosing determined by plasma concentration monitoring and assessment of renal function.

Action

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Inhibits protein synthesis in bacteria at level of 30S ribosome.

Therapeutic effects:

Bactericidal action.

Spectrum:

Notable for activity against.
Enterococci (synergy with a penicillin is required).
Also active against Mycobacterium.

Classifications

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Therapeutic Classification: anti-infectives

Pharmacologic Classification: aminoglycosides

Pharmacokinetics

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Absorption: Well absorbed after IM administration. Negligible absorption when administered orally.

Distribution: Widely distributed throughout extracellular fluid. Poor penetration into CSF.

Metabolism/Excretion: Excretion is >90% renal.

Half-Life: 2–4 hr (↑ in renal impairment).

Time/Action Profile

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(plasma concentrations‡)

ROUTE	ONSET	PEAK	DURATION
IM	rapid	30–90 min	N/A

‡All parenterally administered aminoglycosides.

Patient/Family Teaching

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Instruct patient to report signs of hypersensitivity, tinnitus, vertigo, hearing loss, rash, dizziness, or difficulty urinating.
- Advise patient of the importance of drinking plenty of liquids.
Rep: Advise females of reproductive potential to notify health care professional if pregnancy is planned or suspected or if breastfeeding.

section name header

Indications ⬇

Contraind./Precautions ⬆ ⬇

Adv. Reactions/Side Effects ⬆ ⬇

Interactions ⬆ ⬇

Availability ⬆ ⬇

Route/Dosage ⬆ ⬇

Action ⬆ ⬇

Classifications ⬆ ⬇

Pharmacokinetics ⬆ ⬇

Time/Action Profile ⬆ ⬇

Patient/Family Teaching ⬆ ⬇

Pronunciation ⬆

Indications