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Streptomycin
Pham P and Bartlett JG
06-17-2008
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Available formulation in Zambia (Powder for injection): 1 g (as sulfate) vial.
- Addition of streptomycin to EZRH (Ethambutol, Pyrazinamide, Rifampin, and Isoniazid) recommended during first 2 months in TB-smear positive re-treatment cases (e.g. treatment failure, treatment after default, smear positive relapse).
- Brucellosis (esp. with for osteo-articular or cardiac involvement): streptomycin 1gm IM q24h x 3 weeks PLUS doxycycline 100 mg PO q12h x 6 wks
- Streptomycin should be avoided in pregnant patients, patients with impaired renal function, and elderly (>65 years old).
Zambia Information Author: Paul A. Pham Pharm.D.
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Mycobacterium tuberculosis
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Yersinia pestis (plague)
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Francisella tularensis (tularemia)
- Brucella infection
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Calymmatobacterium granulomatis (Donovanosis, granuloma inguinale),
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Haemophilus ducreyi (chancroid)
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Urinary tract infections
- Endocarditis caused by Streptococcus viridans, Enterococcus faecalis (use with ampicillin)
- Gram-negative bacillary bacteremia (concomitantly with another antibacterial agent)
brand
name
| generic
| Mfg
| brand
forms
| cost*
|
| Streptomycin | Streptomycin | X-Gen | IM
vial
1g | $9.10 |
*Prices represent cost per unit specified and are representative of "Average Wholesale Price" (AWP).
AWP Prices were obtained and gathered by Lakshmi Vasist Pharm D using the Red Book, manufacturer's
information, and the McKesson database.
^Dosage is indicated in mg unless otherwise noted.
- TB: 15mg/kg/d (max 1gm) IM once daily.
- TB DOT regimen:25-30mg/kg IM 2-3x/wk.
- Enterococcal endocarditis (synergy with ampicillin if resistant to gentamicin and sensitive to streptomycin): 7.5mg/kg IM q12h (max dose per day is 2gm with a target peak 1hour after IM dose of 20mcg/ml).
15 mg/kg q24-72h (monitor serum concentrations).
15mg/kg q72-96h (monitor serum concentrations).
7.5mg/kg q72-96h (monitor serum concentrations).
12-15mg/kg 2-3x/week (monitor serum concentrations).
20-40mg/Liter of dialysate per day (monitor serum concentrations closely).
15 mg/kg q24 to 72h (dose adjust based on serum concentrations).
- Renal failure
- Oto/vestibular damage. The most ototoxic of all aminoglycosides. Peak should not exceed 20-25 mcg/mL.
- Optic nerve dysfunction
- Peripheral neuritis
- Arachnoiditis
- Neuromuscular blockade
- Encephalopathy
- Loop diuretic (especially w/ ethacrynic acid): additive ototoxicity. Avoid co-administration with streptomycin.
- Non-depolarizing muscle relaxant (e.g., atracurium, pancuronium, tubocurarine, gallamine triethiodide): may increase risk of neuromuscular blockade with large doses. Use with close monitoring.
- Nephrotoxic agents (e.g., cidofovir, foscarnet, pentamidine, ampho B): may increase risk of nephrotoxicity. Avoid co-administration with streptomycin.
Gram-negatives
Parenteral aminoglycoside with the most ototoxicity potential. Use is generally limited to treatment of multiple-drug resistant tuberculosis (MDRTB), but high rates of streptomycin resistance has been described in high-incidence countries. Also used for unusual infections: plague, tularemia and brucellosis. May be synergistic with ampicillin in cases of gentamicin resistant enterococcus endocarditis.
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