Streptomycin Side Effects

It is possible that some side effects of streptomycin may not have been reported. These can be reported to the FDA here. Always consult a healthcare professional for medical advice.

For the Consumer

Applies to streptomycin: intramuscular powder for solution, intramuscular solution

As well as its needed effects, streptomycin may cause unwanted side effects that require medical attention.

If any of the following side effects occur while taking streptomycin, check with your doctor or nurse immediately:

More common
  • Black, tarry stools
  • burning, crawling, itching, numbness, prickling, "pins and needles", or tingling feelings
  • chest pain
  • chills
  • clumsiness
  • cough
  • dizziness or lightheadedness
  • feeling of constant movement of self or surroundings
  • fever
  • large, hive-like swelling on the face, eyelids, lips, tongue, throat, hands, legs, feet, or sex organs
  • nausea
  • painful or difficult urination
  • sensation of spinning
  • shortness of breath
  • sore throat
  • sores, ulcers, or white spots on the lips or in the mouth
  • swollen glands
  • unsteadiness
  • unusual bleeding or bruising
  • unusual tiredness or weakness
  • vomiting
Less common
  • Back, leg, or stomach pains
  • bleeding gums
  • bloody or cloudy urine
  • blurred vision
  • change in vision
  • dark urine
  • deafness
  • difficulty with breathing
  • difficulty with swallowing
  • dry mouth
  • fast heartbeat
  • general body swelling
  • headache
  • hives
  • impaired vision
  • itching
  • loss of appetite
  • muscle weakness
  • nosebleeds
  • pain in lower back or side
  • pale skin
  • pinpoint red spots on the skin
  • puffiness or swelling of the eyelids or around the eyes, face, lips, or tongue
  • skin rash
  • thirst
  • tightness in the chest
  • wheezing
  • yellowing of the eyes or skin
Rare
  • Change in the frequency of urination or amount of urine
  • drowsiness
  • increased thirst
  • swelling of the feet or lower legs
  • weakness

Some streptomycin side effects may not need any medical attention. As your body gets used to the medicine these side effects may disappear. Your health care professional may be able to help you prevent or reduce these side effects, but do check with them if any of the following side effects continue, or if you are concerned about them:

More common
  • Hives or welts
  • redness of the skin
Less common
  • Impaired vision

For Healthcare Professionals

Applies to streptomycin: compounding powder, intramuscular powder for injection

General

Common side effects of streptomycin have included vestibular toxicity (nausea, vomiting, vertigo), paresthesia of the face, rash, fever, urticaria, angioneurotic edema, and eosinophilia. Side effects may be more likely and more severe in patients with underlying renal insufficiency.[Ref]

Nervous system

Nervous system side effects have included eighth cranial nerve toxicity, which typically affects the vestibular system, but may also affect the auditory component. Streptomycin has more vestibulotoxicity than cochlear toxicity. Vestibulotoxicity is usually reversible with early detection and discontinuation of streptomycin. Cochlear toxicity is often irreversible.

A large percentage of patients receiving daily doses of 1.8 to 2 grams are likely to develop symptoms of vestibular toxicity within 4 weeks, especially the elderly or renally impaired.

Scotomas, presenting as blind spots, and peripheral neuritis have been reported.[Ref]

Previous exposure to aminoglycosides, concomitant use of other potentially ototoxic agents (such as aspirin), and advanced age may provide additional risk of ototoxicity. If symptoms of dizziness, ataxia, tinnitus, vertigo, headache, or decreased hearing occur, alternate therapy should be considered. Baseline and monthly auditory testing should be considered during chronic use of streptomycin, such as in the case of tuberculosis therapy, since ototoxicity may be detected before it becomes clinically evident.

Streptomycin has been reported to possess neuromuscular blocking properties. Extremely high doses of streptomycin have allegedly resulted in lethal neuromuscular blockade.[Ref]

Hypersensitivity

Two reported cases of streptomycin hypersensitivity have involved acute renal failure. In one patient hemolytic anemia was also present and antibodies to streptomycin were detected. Each of these patients had received streptomycin prior to the reaction.[Ref]

Hypersensitivity side effects have been reported infrequently. Cases of anaphylaxis, erythema multiforme, Stevens Johnson syndrome, toxic epidermal necrolysis, pruritus, urticaria, eosinophilia, and rash have been attributed to immune-mediated hypersensitivity reactions to streptomycin. Hypersensitivity myocarditis has also been reported.[Ref]

Renal

Renal side effects have included nephrotoxicity, azotemia, and renal electrolyte wasting. Nephrotoxicity is less common than with other aminoglycosides. Streptomycin-induced nephrotoxicity may be more likely in patients with preexisting renal insufficiency.[Ref]

Risk factors for the development of streptomycin nephrotoxicity include preexisting renal insufficiency, advanced age, concomitant use of other potentially nephrotoxic drugs, and previous exposure to aminoglycoside therapy. Acute renal failure has also occurred as part of an immune-mediated reaction.[Ref]

Hematologic

Aplastic anemia has been reported in patients receiving streptomycin in combination with other antituberculous drugs. Implication of streptomycin as the offending agent is difficult.

The development of a streptomycin-specific antibody directed against red blood cells has been reported, but no hemolysis occurred.[Ref]

Hematologic side effects have included hypersensitivity-associated eosinophilia, and rarely, aplastic anemia, leukopenia, thrombocytopenia, pancytopenia, and hemolytic anemia.[Ref]

Other

Rechallenge with streptomycin reproduced fevers and shaking chills in a patient who had otherwise begun to recover from tuberculosis, was HIV-negative, and who had no other source of infection.[Ref]

Other side effects have included a rare case of recurrent fever and shaking chills. Streptomycin is a potent sensitizer and often causes local irritation in ocular tissues.[Ref]

Gastrointestinal

Gastrointestinal side effects have included nausea and vomiting, which should be evaluated as possible signs of vestibular ototoxicity.[Ref]

References

1. Hasanjani Roushan MR, Mohraz M, Hajiahmadi M, Ramzani A, Valayati AA "Efficacy of Gentamicin plus Doxycycline versus Streptomycin plus Doxycycline in the Treatment of Brucellosis in Humans." Clin Infect Dis 42 (2006): 1075-80

2. "Product Information. Streptomycin (streptomycin)." Pfizer US Pharmaceuticals, New York, NY.

3. "Multum Information Services, Inc. Expert Review Panel"

4. Goldstein JH "Effects of drugs on cornea, conjunctiva, and lids." Int Ophthalmol Clin 11 (1971): 13-34

5. Peloquin CA, Berning SE, Nitta AT, et al. "Aminoglycoside Toxicity: Daily versus Thrice-Weekly Dosing for Treatment of Mycobacterial Diseases." Clin Infect Dis 38 (2004): 1538-44

6. Kaeser HE "Drug-induced myasthenic syndromes." Acta Neurol Scand 70 (1984): 39-47

7. Deka RC, Ghosh P, Kacker SK "Streptomycin ototoxicity: an audiologic and vestibular study." Ear Nose Throat J 56 (1977): 218-24

8. Siegenthaler WE, Bonetti A, Luthy R "Aminoglycoside antibiotics in infectious diseases: an overview." Am J Med 80 (1986): 2-14

9. Yoshikawa TT, Nagami PH "Adverse drug reactions in TB therapy: risks and recommendations." Geriatrics 37 (1982): 61-3, 67-8

10. Pittinger CB, Eryasa Y, Adamson R "Antibiotic-induced paralysis." Anesth Analg 49 (1970): 487-501

11. Wilson WR, Wilkowske CJ, Wright AJ, Sande MA, Geraci JE "Treatment of streptomycin-susceptible and streptomycin-resistant enterococcal endocarditis." Ann Intern Med 100 (1984): 816-23

12. Mathog RH, Klein WJ "Ototoxicity of ethacrynic acid and aminoglycoside antibiotics in uremia." N Engl J Med 280 (1969): 1223-4

13. Edwards KD, Whyte HM "Streptomycin poisoning in renal failure: an indication for treatment with an artificial kidney." Br Med J Mar (1959): 752-4

14. Wilson WR, Thompson RL, Wilkowske CH, Washington JA, Giuliani ER, Geraci JE "Short-term therapy for streptococcal infective endocarditis." JAMA 245 (1981): 360-3

15. Rance F, Randall B "Fatal intravenous drug abuse secondary to streptomycin overdose." J Forensic Sci 31 (1986): 1150-3

16. Sarkar SK, Purohit SD, Sharma TN, Chawla MP, Gupta DN "Stevens-Johnson syndrome caused by streptomycin." Tubercle 63 (1982): 137-8

17. McQueen EG "Antibiotic allergy and acute renal failure." N Z Med J 64 (1965): 561-3

18. Hmouda H, Laouani-Kechrid C, Nejib Karoui M, Denguezli M, Nouira R, Ghannouchi G "A rare case of streptomycin-induced toxic epidermal necrolysis in a patient with tuberculosis: a therapeutic dilemma." Ann Pharmacother 39 (2004): 165-8

19. Letona JM, Barbolla L, Frieyro E, et al "Immune haemolytic anaemia and renal failure induced by streptomycin." Br J Haematol 35 (1977): 561-71

20. Holdiness MR "Adverse cutaneous reactions to antituberculosis drugs." Int J Dermatol 24 (1985): 280-5

21. Kushimoto H, Aoki T "Toxic erythema with generalized follicular pustules caused by streptomycin." Arch Dermatol 117 (1981): 444-5

22. Kounis GN, Kouni SA, Chiladakis JA, Kounis NG "Comment: Mesalamine-Associated Hypersensitivity Myocarditis in Ulcerative Colitis and the Kounis Syndrome (February)." Ann Pharmacother 43 (2009): 393-4

23. Dhamgaye T, Mohanty KC "Hypersensitivity to multiple drugs streptomycin, rifamipicin and ethambutol - an unusual presentation." Tuber Lung Dis 76 (1995): 181

24. Dhamgaye T, Mohanty KC "Hypersensitivity to multiple drugs streptomycin, rifamipicin and ethambutol - an unusual presentation." Tuber Lung Dis 76 (1995): 181

25. Fuchs S, Kaminski N, Brezis M "Metabolic abnormality induced streptomycin." BMJ 309 (1994): 512

26. Florendo NT, MacFarland D, Painter M, Muirhead EE "Streptomycin-specific antibody coincident with a developing warm autoantibody." Transfusion 20 (1980): 662-8

27. Williams CK, Aderoju EA, Adenle AD, Sekoni G, Esan GJ "Aplastic anaemia associated with anti-tuberculosis chemotherapy." Acta Haematol 68 (1982): 329-32

28. Feldbaum JS, Silverstein H "Streptomycin drug fever during treatment of bilateral Meniere's disease." Arch Otolaryngol 110 (1984): 538-9

29. Arroyo JC "Streptomycin-induced fever confirmed by rechallenge." Am J Med 86 (1989): 136-7

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