streptomycin

strep-toe-MYE-sin

Therapeutic Classification: anti-infectives

Pharmacologic Classification: aminoglycosides

REMS

In combination with other agents in the management of active tuberculosis.
In combination with other agents in the management of serious enterococcal or gram-negative infections.

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.

Absorption: Well absorbed after IM and intra-peritoneal administration. Negligible absorption when administered orally.

Distribution: Widely distributed throughout extracellular fluid; crosses the placenta; small amounts enter breast milk. Poor penetration into CSF.

Metabolism/Excretion: Excretion is >90% renal.

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

(blood levels‡)

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

‡All parenterally administered aminoglycosides.

Contraindicated in:

Hypersensitivity;
Cross-sensitivity among aminoglycosides may occur.

Use Cautiously in:

Renal impairment (dosage adjustments necessary; blood level monitoring useful in preventing ototoxicity and nephrotoxicity);
Hearing impairment;
Geriatric patients and premature infants (difficulty in assessing auditory and vestibular function; age-related renal impairment);
Neuromuscular diseases such as myasthenia gravis;
Obese patients (dosage should be based on ideal body weight);
Neonates (increased risk of neuromuscular blockade; difficulty in assessing auditory and vestibular function; immature renal function);
Pregnancy (may cause congenital deafness);
Lactation (safety not established).

EENT: ototoxicity (vestibular and cochlear)

GU: nephrotoxicity

F and E: hypomagnesemia

MS: muscle paralysis (high parenteral doses)

Misc: hypersensitivity reactions

Drug-drug:

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

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

Renal Impairment

IM (Adults ): 1 g initially, further dosing determined by blood level monitoring and assessment of renal function.

(Generic available)

Injection: 500 mg/mL; 1 g

Assess patient for infection (vital signs, wound appearance, sputum, urine, stool, WBC) at beginning of and throughout therapy.
Obtain specimens for culture and sensitivity before initiating therapy. First dose may be given before receiving results.
Evaluate eighth cranial nerve function by audiometry before and throughout therapy. Hearing loss is usually in the high-frequency range. Prompt recognition and intervention are essential in preventing permanent damage. Also monitor for vestibular dysfunction (vertigo, ataxia, nausea, vomiting). Eighth cranial nerve dysfunction is associated with persistently elevated aminoglycoside levels. Aminoglycosides should be discontinued if tinnitus or subjective hearing loss occurs.
Monitor intake and output and daily weight to assess hydration status and renal function.
Assess patient for signs of superinfection (fever, upper respiratory infection, vaginal itching or discharge, increasing malaise, diarrhea). Report to physician or other health care professional.

Lab Test Considerations:

Monitor renal function by urinalysis, specific gravity, BUN, creatinine, and CCr before and throughout therapy.
- May cause increased BUN, AST, ALT, serum alkaline phosphatase, bilirubin, creatinine, and LDH concentrations.
- May cause decreased serum calcium, magnesium, potassium, and sodium concentrations.

Toxicity and Overdose:

Blood levels should be monitored periodically during therapy. Timing of blood levels is important in interpreting results. Draw blood for peak levels 1 hr after IM injection and 30 min after a 30-min IV infusion is completed. Trough levels should be drawn just before next dose. Peak level should not exceed 25 mcg/mL.

Keep patient well hydrated (1500–2000 mL/day) during therapy.
IM: IM administration should be deep into a well-developed muscle. Alternate injection sites.

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.

Resolution of the signs and symptoms of infection. If no response is seen within 3–5 days, new cultures should be taken.

Risk for infection(Indications)
Disturbed sensory perception(auditory)(Side Effects)
Deficient knowledge, Relate med(Patient/Family Teaching)

NDC Code

39822- X-GEN Pharmaceuticals, Inc.
- 39822-0706- Streptomycin
  - 39822-0706-2- 10 VIAL in 1 BOX (39822-0706-2) > 1 INJECTION, POWDER, LYOPHILIZED, FOR SOLUTION in 1 VIAL (39822-0706-1)

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Pronunciation ⬇

Classifications ⬆ ⬇

Indications ⬆ ⬇

Action ⬆ ⬇

Pharmacokinetics ⬆ ⬇

Time/Action Profile ⬆ ⬇

Contraind./Precautions ⬆ ⬇

Adv. Reactions/Side Effects ⬆ ⬇

Interactions ⬆ ⬇

Route/Dosage ⬆ ⬇

Availability ⬆ ⬇

Assessment ⬆ ⬇

Implementation ⬆ ⬇

Patient/Family Teaching ⬆ ⬇

Evaluation/Desired Outcomes ⬆ ⬇

Pot. Nursing Diagnoses ⬆ ⬇

Code ⬆