(1991; 44 pages) [French] [Spanish]
Group: antimycobacterial agent
Powder for injection 1 g base (as sulfate) in vial
An aminoglycoside antibiotic derived from Streptomyces griseus that is used in the treatment of tuberculosis and sensitive Gram-negative infections.
Streptomycin is not absorbed from the gastrointestinal tract but, after intramuscular administration, it diffuses readily into the extracellular component of most body tissues and it attains bactericidal concentrations, particularly in tuberculous cavities. Little normally enters the cerebrospinal fluid, although penetration increases when the meninges are inflamed. The plasma half-life, which is normally 2-3 hours, is considerably extended in the newborn, in the elderly and in patients with severe renal impairment. It is excreted unchanged in the urine.
A component of several combined anti-tuberculosis chemotherapeutic regimens currently recommended by WHO (see pages 12 and 13), of particular use when primary resistance to other drugs is suspected.
Dosage and administration
Streptomycin must be administered by deep intramuscular injection. Syringes and needles should be adequately sterilized, to exclude any risk of transmitting viral pathogens.
Adults and children: 15 mg/kg daily or two or three times weekly. Patients over 60 years may not be able to tolerate more than 500-750 mg daily.
• Known hypersensitivity.
• Auditory nerve impairment.
• Myasthenia gravis.
Should hypersensitivity reactions occur, as is common during the first weeks of treatment, streptomycin should be withdrawn immediately. Once fever and skin rash have resolved, desensitization may be attempted.
Streptomycin should be avoided, when possible, in children because the injections are painful and irreversible auditory nerve damage may occur. Both the elderly and patients with renal impairment are also vulnerable to dose-related toxic effects resulting from accumulation. Serum levels should be monitored periodically and dosage adjusted appropriately to ensure that plasma concentrations, as measured when the next dose is due, do not rise above 4 micrograms/ml.
Protective gloves should be worn when streptomycin injections are administered, to avoid sensitization dermatitis.
Use in pregnancy
Streptomycin should not be used in pregnancy. It crosses the placenta and can cause auditory nerve impairment and nephro-toxicity in the fetus.
Injections are painful and sterile abscesses can form at injection sites. Hypersensitivity reactions are common and can be severe.
Impairment of vestibular function is uncommon with currently recommended doses. Dosage should be reduced if head-ache, vomiting, vertigo and tinnitus occur.
Streptomycin is less nephrotoxic than other aminoglycoside antibiotics. None the less, close monitoring of renal function is necessary. Dosage must be reduced by half immediately if urinary output falls, if albuminuria occurs or if tubular casts are detected in the urine.
Haemolytic anaemia, aplastic anaemia, agranulocytosis, thrombocytopenia and lupoid reactions are rare adverse effects.
Other ototoxic or nephrotoxic drugs should not be administered to patients receiving streptomycin. These include other aminoglycoside antibiotics, amphotericin B, cefalosporins, etacrynic acid, ciclosporin, cisplatin, furosemide and vancomycin.
Streptomycin may potentiate the effect of neuromuscular blocking agents administered during anaesthesia.
Haemodialysis can be beneficial. There is no specific antidote and treatment is supportive.
Solutions retain their potency for 48 hours after reconstitution at room temperature and for up to 14 days when refrigerated. Powder for injection should be stored in tightly closed containers protected from light.