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Streptomycin Sulfate

Pronouncation: (strep-toe-MY-sin Sull-fate)
Class: Aminoglycoside, parenteral, Antituberculosis agent

Trade Names:
Streptomycin Sulfate
- Injection 400 mg/mL
- Lyophilized cake/Powder for injection 200ߙmg/mL

Pharmacology

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Compare with other drugs.

Interferes with protein synthesis.

Pharmacokinetics

Absorption

Peak serum levels are reached within 1 hr following IM injection.

Distribution

Appreciable concentrations are found in all organ tissue except the brain.

Elimination

Following a single 600 mg dose, 29% to 89% is excreted in the urine within 24ߙhr.

Indications and Usage

Treatment of moderate to severe infections caused by susceptible strains of Mycobacterium tuberculosis and nontuberculosis infections.

Contraindications

Hypersensitivity to aminoglycosides or any component of the product.

Dosage and Administration

Tuberculosis
Adults

IM 15 mg/kg/day (max, 1 g) or 25 to 30 mg/kg 2 or 3 times weekly (max, 1.5 g).

Children

IM 20 to 40 mg/kg/day (max, 1 g) or 25 to 30 mg/kg 2 or 3 times weekly (max, 1.5ߙg).

Tularemia

IM 1 to 2 g/day in divided doses for 7 to 14ߙdays until patient is afebrile for 5 to 7 days.

Plague

IM 2 g/day in 2 divided doses for minimum of 10 days.

Bacterial Endocarditis
Streptococcal

IM 1 g twice daily for 1 wk then 0.5 g twice daily for the second week in combination with penicillin. In patients older than 60 yr of age, give 0.5 g twice daily for the entire 2 wk period.

Enterococcal

IM 1 g twice daily for 2 wk and 0.5 g twice daily for 4 wk in combination with penicillin.

Concomitant Use with Other Agents
Adults

IM 1 to 2 g in divided doses every 6 to 12 hr for moderate to severe infections (max, 2ߙg/day).

Children

IM 20 to 40 mg/kg/day in divided doses every 6 to 12 hr, avoiding excessive doses.

Storage/Stability

Store injection in refrigerator (36° to 46°F). Store cake/powder for injection at controlled room temperature (59° to 86°F). Reconstituted solution may be stored for up to 1 wk at controlled room temperature (59° to 86°F). Protect reconstituted solution from light.

Drug Interactions

Ethacrynic acid, furosemide, mannitol, possibly other diuretics

May potentiate the ototoxic effects of streptomycin.

Neurotoxic or nephrotoxic agents (eg, colistin, cyclosporine, gentamicin, kanamycin, neomycin, paromomycin, polymyxin B, tobramycin)

May increase the risk of neuro- or nephrotoxicity and should be avoided.

Laboratory Test Interactions

None well documented.

Adverse Reactions

Dermatologic

Rash; urticaria; exfoliative dermatitis.

EENT

Vestibular ototoxicity (eg, nausea, vomiting, vertigo); cochlear ototoxicity (deafness); amblyopia.

Genitourinary

Azotemia; nephrotoxicity.

Hematologic

Eosinophilia; leukopenia; thrombocytopenia; pancytopenia; hemolytic anemia.

Miscellaneous

Paresthesia of face; fever; angioneurotic edema; anaphylaxis; muscular weakness.

Precautions

Warnings

Neurotoxicity

Risk of severe neurotoxic reactions (including cochlear and vestibular dysfunction, optic nerve dysfunction, peripheral neuritis, arachnoiditis, and encephalopathy) increase in patients with impaired renal function or pre-renal azotemia.

Nephrotoxicity

Avoid concurrent use of nephrotoxic/neurotoxic drugs.

Monitor renal function carefully. Patients with reduced function should have reduced doses. Peak serum concentrations in patients with renal dysfunction should be 20 to 25 mcg/mL or less.

Pregnancy

Category D . Crosses the placenta and may cause fetal harm.

Lactation

Excreted in breast milk.

Children

See Route/Dosage section.

Elderly

Because of increased risk of side effects, reduce the dose in patients older than 60 yr of age.

Superinfection

May result in bacterial or fungal overgrowth of nonsusceptible microorganisms.

Ototoxicity

May occur.

Nitrogen retention

Reduced doses are necessary.

Patient Information

Advise patient that medication will be prepared and administered by a health care provider in a health care setting.
Review dosing schedule and prescribed length of therapy with patient.
Instruct patient to immediately report the following to health care provider: headache, nausea, vomiting, ringing in the ears, vertigo (feeling of whirling motion), dizziness, roaring noises, sense of fullness in ears, hearing loss, itching, rash.