streptomycin sulfate

streptomycin sulfate

[strep′təmī′sin]

an aminoglycoside antibiotic.

indications It is prescribed in the treatment of tuberculosis, endocarditis, and certain other infections.

contraindications Pregnancy or hypersensitivity to this drug prohibits its use. It must be used with caution in individuals who have vertigo, tinnitus, other manifestations of labyrinthine disease, or impaired renal function and in the elderly.

adverse effects Among the most serious adverse effects are ototoxicity (generally irreversible), nephrotoxicity (generally reversible), muscle weakness, and allergic reactions.

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streptomycin sulfate

Pharmacologic class: Aminoglycoside

Therapeutic class: Anti-infective

Pregnancy risk category D

FDA Boxed Warning

• Risk of severe neurotoxic reactions (including vestibular and cochlear dysfunction) is markedly higher in patients with impaired renal function or prerenal azotemia. Incidence of clinically detectable, irreversible vestibular damage is particularly high.
• Neurotoxicity can lead to respiratory paralysis from neuromuscular blockade, especially when drug is given soon after anesthesia or muscle relaxants.
• Monitor renal function carefully; reduce dosage in patients with renal impairment or nitrogen retention.
• Avoid concurrent or sequential use of other neurotoxic or nephrotoxic drugs, including cephaloridine, colistin, cyclosporine, gentamicin, kanamycin, neomycin, paromomycin, polymyxin B, tobramycin, and viomycin.
• Reserve parenteral administration for settings where adequate laboratory and audiometric studies are available during therapy.

Action

Binds to 30S ribosomal subunit, inhibiting protein synthesis in bacterial cell, which causes misreading of genetic code and, ultimately, cell death

Availability

Injection: 400 mg/ml in 2.5-ml ampules, 200 mg/ml in 1-g vials

⊘Indications and dosages

➣ Adjunct in tuberculosis and other mycobacterial infections

Adults: 15 mg/kg/day I.M., up to 1 g/day

Children: 20 to 40 mg/kg I.M. daily, up to 1 g/day

➣ Enteroccocal or streptococcal infections

Adults: 1 g I.M. b.i.d. for 1 week, then 500 mg I.M. b.i.d. for 1 week. For enterococcal endocarditis, 1 g I.M. b.i.d. given with penicillin for 1 week, then 500 mg I.M. b.i.d. for 4 weeks.

➣ Brucellosis

Adults: 1 g I.M. once or twice daily with tetracycline or doxycycline for 1 week, then once daily for at least 1 more week

➣ Tularemia

Adults: 1 to 2 g I.M. daily in divided doses for 7 to 14 days until patient is afebrile for 5 to 7 days. For tularemia caused by Francisella tularensis, 1 g I.M. b.i.d. for 10 days or 7.5 to 10 mg/kg I.M. b.i.d. for 10 to 14 days.

➣ Plague caused by Yersinis pestis

Adults: 1 g I.M. b.i.d. for 10 to 14 days

Dosage adjustment

• Renal impairment
• Elderly patients

Off-label uses

• Mycobacterium avium-intracellulare complex in AIDS patients

Contraindications

• Hypersensitivity to drug, other aminoglycosides, or bisulfites

Precautions

Use cautiously in:
• renal impairment, hearing impairment, neuromuscular disease (such as myasthenia gravis)
• elderly patients
• pregnant or breastfeeding patients
• infants and neonates (safety not established).

Administration

• Inject I.M. deep into upper outer quadrant of buttock.
• Alternate injection sites.
• Know that drug may be given with other antituberculars.
• Be aware that streptomycin will be withdrawn after several months or when bacteriologic smears are negative and other antituberculars are continued for 1 year.

Route	Onset	Peak	Duration
I.M.	Rapid	30-90 min	Unknown

Adverse reactions

CNS: vertigo, numbness and tingling, peripheral neuropathy, myasthenia gravis-like syndrome, neuromuscular blockade, seizures

CV: myocarditis

EENT: amblyopia, ototoxicity

GI: nausea, vomiting

GU: azotemia, nephrotoxicity

Hematologic: eosinophilia, hemolytic anemia, pancytopenia, leukopenia, thrombocytopenia

Hepatic: hepatic necrosis

Musculoskeletal: muscle weakness, twitching

Respiratory: apnea

Skin: rash, urticaria, exfoliative dermatitis, toxic epidermal necrolysis, angioedema

Other: fever, superinfection, serum sickness, anaphylaxis

Interactions

Drug-drug. Acyclovir, amphotericin B, cephalosporin, cisplatin, potent diuretics, vancomycin: increased risk of ototoxicity and nephrotoxicity

Depolarizing and nondepolarizing neuromuscular blockers, general anesthetics: potentiation of neuromuscular blockade

Dimenhydrinate: masking of ototoxicity symptoms

Indomethacin: increased streptomycin peak and trough blood levels

Parenteral penicillins (ampicillin, ticarcillin): streptomycin inactivation

Drug-diagnostic tests. Bilirubin, blood urea nitrogen, creatinine, lactate dehydrogenase, nonprotein nitrogen: increased levels

Granulocytes, hemoglobin, platelets, white blood cells: decreased levels

Patient monitoring

• Draw blood for peak drug level 1 hour after I.M. injection. Draw blood for trough level just before next dose.
• Monitor liver and kidney function tests. Watch for evidence of hepatotoxicity and nephrotoxicity.
• Monitor temperature. Stay alert for fever and other signs and symptoms of superinfection.
• Assess neurologic status and sensory function carefully. Watch closely for neurotoxicity, neuromuscular blockade, and seizures.
• Assess for signs and symptoms of ototoxicity.
• Monitor CBC. Watch for evidence of blood dyscrasias.

Patient teaching

• Instruct patient to report unusual bleeding or bruising.
☞ Inform patient that drug can be toxic to many body systems. Teach him to recognize and immediately report serious adverse reactions.
☞ Tell patient drug may promote growth of certain organisms. Advise him to immediately report signs and symptoms of superinfection.
• Inform patient that drug may impair cognitive, motor, and sensory function. Advise him to use caution when driving and performing other hazardous activities.
• As appropriate, review all other significant and life-threatening adverse reactions and interactions, especially those related to the drugs and tests mentioned above.