streptomycin

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.

Contraind./Precautions ⬆ ⬇

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).

Adv. Reactions/Side Effects ⬆ ⬇

EENT: ototoxicity (vestibular and cochlear)

GU: nephrotoxicity

F and E: hypomagnesemia

MS: muscle paralysis (high parenteral doses)

Misc: hypersensitivity reactions

Interactions ⬆ ⬇

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.

Availability ⬆ ⬇

(Generic available)

Injection: 500 mg/mL; 1 g

Route/Dosage ⬆ ⬇

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.

Action ⬆ ⬇

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 ⬆ ⬇

Therapeutic Classification: anti-infectives

Pharmacologic Classification: aminoglycosides

Pharmacokinetics ⬆ ⬇

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).

Time/Action Profile ⬆ ⬇

(blood levels‡)

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

‡All parenterally administered aminoglycosides.

Patient/Family Teaching ⬆ ⬇

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.

Pronunciation ⬆ ⬇

Code ⬆

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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Indications ⬇