Dosing and uses of Streptomycin
Adult dosage forms and strengths
powder for injection
- 1g
Moderate-Severe Infections
1-2 g/day IM divided q6-12hr; no more than 2 g/day
Tuberculosis
Daily therapy: 15 mg/kg IM qDay; no more than 1 g/day
Twice weekly therapy: 25-30 mg/kg IM 2 times/week; no more than 1.5 g/day
Tularemia
1-2 g IM in divided doses for 7-10 days or until patient is afebrile for 5-7 days
Plague
15 mg/kg IM q12hr for minimum 10 days
Streptococcal Endocarditis
1 g IM q12hr for 7 days, THEN 500 mg q12hr for 7 days, concomitant with penicillin
If >60 years old, 500 mg q12hr for entire 14 days
Enterococcal Endocarditis
1 g IM q12hr for 2 weeks, THEN 500 mg q12hr for 4 weeks, concomitant with penicillin
Brucellosis
1 g IM qDay/BID for 1 week, THEN qDay for 1 week in conjunction with doxycycline or tetracycline
Renal Impairment
Load: 1 g IM, THEn
CrCl: 50-80 mL/min: 7.5 mg/kg IM q24hr
CrCl: 10-50 mL/min: 7.5 mg/kg IM q24-72hr
CrCl <10 mL/min: 7.5 mg/kg IM q72-96hr
Hemodialysis: 50-75% of initial loading dose at end of dialysis period
Pediatric dosage forms and strengths
powder for injection
- 1g
injectable solution
- 400mg/mL
Moderate to Severe Infections
20-40 mg/kg/day IM divided q6-12 hr
Tuberculosis
Daily therapy: 20-40 mg/kg IM qDay; no more than 1 g/day
Twice wekly therapy: 20-40 mg/kg IM 2 times/week; no more than 1.5 g/day
Plague
15 mg/kg IM q12hr for minimum 10 days; no more than 2 g/day
Brucellosis
>8 years old: 20 mg/kg IM divided q12hr during 7-14 days of tetracycline or co-trimoxazole therapy; no more than 1 g/day
Streptomycin adverse (side) effects
Frequency not defined
Hypotension
Neurotoxicity
Drowsiness
Headache
Drug fever
Paresthesia
Skin rash
Nausea
Vomiting
Eosinophilia
Anemia
Arthralgia
Weakness
Tremor
Ototoxicity (auditory)
Ototoxicity (vestibular)
Nephrotoxicity
Difficulty in breathing
Warnings
Black box warnings
May cause nephrotoxicity and neurotoxicity. Avoid concurrent use of nephrotoxic/neurotoxic drugs.
May cause neuromuscular blockade and respiratory paralysis, especially when given after anesthesia or muscle relaxants. Use the parenteral form only where appropriate audiometric and laboratory testing facilities are available.
Contraindications
Hypersensitivity to streptomycin or other aminoglycosides; severe hypersensitivity to sulfites
Concomitant live bacterial vaccines
Cautions
For tuberculosis, do not exceed 120 g total over course of Tx; discontinue in case of toxicity or organism resistance
For endocarditis, discontinue in case of ototoxicity
Reduce dosage in case of renal impairment: serum conc. should not exceed 20-25 mcg/mL
Pregnancy and lactation
Pregnancy category: d
Lactation: enters breast milk (AAP Committee states compatible w/ nursing)
Pregnancy categories
A: Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.
B: May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk.
C: Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done.
D: Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk.
X: Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist.
NA: Information not available.
Pharmacology of Streptomycin
Absorption: IM: well absorbed; not absorbed from gut
Distribution: to extracellular fluid including serum, abscesses, ascitic, pericardial, pleural, synovial, lymphatic, & peritoneal fluids; crosses placenta; small amounts enter breast milk
Protein Bound: 34%
Half-life elimination: newborns: 4-10 hr; adults: 2-4.7 hr, prolonged with renal impairment
Peak Plasma Time: within 1 hr
Excretion: urine (90% as unchanged drug); feces, saliva, sweat, & tears (<1%)
Mechanism of action
Interferes with normal bacterial protein synthesis by binding to the 30S ribosomal subunits
Administration
IV Compatibilities
Additive: bleomycin
Syringe: penicillin g
Y-site: esmoloL
IV Incompatibilities
Additive: amobarbital, amphotericin B, chlorothiazide, heparin, methohexital, norepinephrine, pentobarbital, phenobarbital, phenytoin, sodium bicarbonate
Syringe: ampicillin(?), heparin
IV Preparation
Dissolve powder with 4.2, 3.2, or 1.8 mL of SWI to prepare 200 mg/mL, 250 mg/mL, or 400 mg/mL
IV/IM Administration
IM: inject deep IM into large muscle mass
IV: not recommended; has been administered intravenously 12-15 mg/kg in 100 mL of NS over 30-60 min
Storage
Injection: store at 2-8°C
Powder: store at room temp & protect from light
Reconstituted soln stable for 1 wk at room temp; protect from light
Exposure to light causes darkening of solution without apparent loss of potency
