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streptomycin
Indications:
- used in combination therapy for tuberculosis
- used in combination therapy for streptococcal or enterococcal endocarditis
- mycobacterial infections
- plague
- tularemia
- brucellosis
- chancroid
- donovanosis [5]
Contraindications:
- avoid in patients >= 60 years of age [6]
Dosage:
1) adults:
a) tuberculosis:
- 15 mg/kg/day divided every 12 hours
- not to exceed 1 g/day
- generally discontinued after 2-3 months or sooner if cultures become negative
b) enterococcal endocarditis
- 1 g every 12 hours for 2 weeks
- 500 mg every 12 hours for 4 weeks in combination with penicillin
c) streptococcal endocarditis
- 500 mg-1 g every 12 hours for 1 week
- if > 60 years of age, give 500 mg every 12 hours for 2 weeks
d) tularemia: 1-2 g/day divided every 12 hours for 7-14 days or until patient is afebrile for 5-7 days
e) plague: 2 g/day divided every 12 hours for a minimum of 10 days
2) children
- tuberculosis
a) 20-30 mg/kg/day
b) not to exceed 1 g/day
c) generally discontinued after 2-3 months or sooner if cultures become negative
3) IM administration only into large muscle mass
Injection: 400 mg.mL (2.5 mL)
Dosage adjustment in renal failure:
creatinine clearance dosage
50-90 mL/min 50% every 24 hours
10-50 mL/min* every 24-72 hours
< 10 mL/min every 72-96 hours
> 80 mL/min 15 mg/kg every 24 hours
60-80 mL/min 12 mg/kg every 24 hours
40-60 mL/min 7.5 mg/kg every 24 hours
30-40 mL/min 4 mg/kg every 24 hours
20-30 mL/min 7.5 mg/kg every 48 hours
10-20 mL/min 4 mg/kg every 48 hours
< 10 mL/min# 3 mg/kg every 48 hours
* same dose for continuous arteriovenous hemofiltration
# 3 mg/kg after hemodialysis
Monitor:
- streptomycin in serum
- therapeutic range:
- Peak: 10-20 ug/mL
- Trough: < 5 ug/mL
- hearing
- renal function tests [6]
Pharmacokinetics:
1) not absorbed from GI tract; must be given parenterally
2) peak serum concentration 1 hour after IM dose
3) serum concentration of 40 ug/mL with does of 15 mg/kg
4) most strains of M. tuberculosis inhibited by 8 ug/mL
5) good tissue penetration, but CSF penetration only with meningeal inflammation
6) removed by hemodialysis
7) 1/2life 2-3 hours (30-80 hours ESRD)
Antimicrobial activity:
- Mycobacterium avium complex
- Enterobacter
- gram-negative bacteria
- Haemophilus
- Haemophilus influenzae
- Escherichia coli
- Klebsiella
- Proteus [5]
Adverse effects:
1) not common (1-10%)
- nephrotoxicity, neurotoxicity, ototoxicity (auditory & vestibular)
2) uncommon (< 1%)
- rash, drug fever, headache, paresthesia, tremor, nausea/vomiting, eosinophilia, arthralgia, anemia, hypotension, difficulty breathing, drowsiness, weakness
3) other
a) ototoxicity
- tinnitus
- hearing loss
- vertigo
- vestibular toxicity may occur up to 2-3 months after stopping drug
b) adverse effects dose-related & increased with age
Mechanism of action:
- bactericidal against M. tuberculosis in an alkaline environment
Interactions
drug interactions
drug adverse effects of aminoglycosides
General
aminoglycoside antibiotic
anti-tuberculous agent
Properties
MISC-INFO: elimination route KIDNEY
pregnancy-category D
safety in lactation ?
elimination by hemodialysis +
Database Correlations
Kegg map/map00521
References
- The Pharmacological Basis of Therapeutics, 9th ed.
Gilman et al, eds. Permagon Press/McGraw Hill, 1996
- Am Thoracic Soc, Am J Respir Crit Care Med 149:1359, 1994
- Kaiser Permanente Northern California Regional Drug
Formulary, 1998
- Sanford Guide to Antimicrobial Therapy, 2001
- Deprecated Reference
- Medical Knowledge Self Assessment Program (MKSAP) 17,
American College of Physicians, Philadelphia 2015
- Department of Veterans Affairs, VA National Formulary