Comprehensive Guide to Streptomycin: Uses, Dosage, Side Effects, and More

1. What is Streptomycin?

2. Overview of Streptomycin

Generic Name

Streptomycin

Brand Name

Streptomycin Sulfate, generics

Drug Group

Aminoglycoside antibiotic

Commonly Used For

This medication is used to:

• Treat tuberculosis (TB).
• Manage multidrug-resistant bacterial infections.
• Address certain Gram-negative infections.

Key Characteristics

• Form: Powder for injection (1 g/vial) or solution for intramuscular (IM) administration (detailed in Dosage section).
• Mechanism: Binds to the 30S ribosomal subunit, disrupting bacterial protein synthesis.
• Approval: FDA-approved (1940s) and EMA-approved for TB and specific infections.

3. Indications and Uses of Streptomycin

Streptomycin is indicated for a range of bacterial infections, leveraging its bactericidal action against susceptible strains:

• Tuberculosis (TB): Treats active TB, particularly in combination with isoniazid and rifampin, effective against Mycobacterium tuberculosis, per WHO and CDC guidelines, reducing relapse rates in pulmonary and extrapulmonary cases.
• Multidrug-Resistant TB (MDR-TB): Manages MDR-TB when first-line drugs fail, improving outcomes in resistant strains, supported by global TB control programs.
• Plague: Treats Yersinia pestis infections (e.g., bubonic or pneumonic plague), a critical therapy in endemic areas, under infectious disease protocols.
• Tularemia: Addresses Francisella tularensis infections, reducing morbidity, used in combination with other agents, per CDC recommendations.
• Endocarditis: Used off-label for bacterial endocarditis caused by Enterococcus faecalis, often with penicillin, enhancing cure rates, supported by cardiology and infectious disease studies.
• Meningitis: Investigated off-label for bacterial meningitis due to susceptible strains (e.g., Streptococcus pneumoniae), improving outcomes when other treatments fail, with neurology data.
• Brucellosis: Employed off-label in combination therapy for Brucella infections, reducing chronicity, with evidence from infectious disease research.
• Rat-Bite Fever: Managed off-label for Streptobacillus moniliformis infections, alleviating symptoms, supported by rare disease studies.
• Anthrax: Explored off-label as an adjunct for Bacillus anthracis infections, particularly in bioterrorism scenarios, with data from public health initiatives.

Note: This drug requires monitoring for ototoxicity and nephrotoxicity; consult a healthcare provider for prolonged use or combination therapy.

4. Dosage of Streptomycin

Important Note: The dosage of this aminoglycoside must be prescribed by a healthcare provider. Dosing varies by indication, patient weight, and renal function, with adjustments based on clinical evaluation.

Dosage for Adults

• Tuberculosis (TB):
  • 15 mg/kg IM daily (max 1 g/day) or 25–30 mg/kg 2–3 times weekly, combined with other anti-TB drugs, for 6–9 months.
• Multidrug-Resistant TB (MDR-TB):
  • 15 mg/kg IM daily (max 1 g/day), adjusted for resistance, for 6–24 months, under TB specialist supervision.
• Plague or Tularemia:
  • 1–2 g IM daily in divided doses for 7–14 days, or until clinically stable.

Dosage for Children

• Tuberculosis or MDR-TB:
  • 20–40 mg/kg IM daily (max 1 g/day) or 25–30 mg/kg 2–3 times weekly, under pediatric infectious disease supervision.
  • Not recommended under 3 months unless critical.
• Plague or Tularemia:
  • 20–40 mg/kg IM daily (max 1 g/day) in divided doses, for 7–14 days.

Dosage for Pregnant Women

• Pregnancy Category D: Use only if benefits outweigh risks (e.g., severe TB). Consult an obstetrician, with fetal monitoring for ototoxicity.

Dosage Adjustments

• Renal Impairment: Reduce dose based on creatinine clearance (e.g., 7.5 mg/kg every 24–48 hours if CrCl <30 mL/min); monitor levels.
• Hepatic Impairment: No adjustment needed; monitor liver function if co-infected.
• Elderly: Start with 10 mg/kg daily; increase cautiously with monitoring.
• Concomitant Ototoxic Drugs: Avoid or reduce dose if combined with other ototoxic agents (e.g., furosemide).

Additional Considerations

• Administer this active ingredient via deep IM injection or IV infusion (if diluted) by a healthcare provider.
• Monitor peak and trough levels (target: 15–40 mcg/mL peak, <5 mcg/mL trough).

5. How to Use Streptomycin

• Administration:
  • Reconstitute with sterile water or saline, administer via deep IM injection, or dilute for IV infusion over 30–60 minutes; avoid rapid IV push.
  • Use with hydration to minimize nephrotoxicity.
• Timing: Use daily or as scheduled (e.g., 2–3 times weekly for TB), maintaining consistency.
• Monitoring: Watch for hearing changes, dizziness, or signs of kidney issues (e.g., reduced urine output).
• Additional Tips:
  • Store at 20–25°C (68–77°F) or 2–8°C (36–46°F) if unopened; protect from light.
  • Keep out of reach of children due to toxicity risk.
  • Report tinnitus, balance issues, or signs of allergic reaction immediately.

6. Contraindications for Streptomycin

This drug is contraindicated in:

• Hypersensitivity: Patients with a known allergy to Streptomycin or other aminoglycosides.
• Severe Renal Impairment: Contraindicated if CrCl <10 mL/min due to accumulation risk.
• Preexisting Auditory Impairment: Avoid in patients with significant hearing loss.
• Myasthenia Gravis: Contraindicated due to neuromuscular blockade risk.

7. Warnings & Precautions for Streptomycin

General Warnings

• Ototoxicity: Risk of irreversible hearing loss or vestibular damage; monitor audiometry regularly.
• Nephrotoxicity: Risk of acute kidney injury; check renal function weekly.
• Neuromuscular Blockade: Risk in myasthenia gravis or postoperative patients; use cautiously.
• Superinfections: Risk of resistant bacteria or fungi; monitor for secondary infections.
• Hypersensitivity Reactions: Rare anaphylaxis; discontinue if swelling occurs.

Additional Warnings

• Electrolyte Imbalance: Risk of hypomagnesemia or hypocalcemia; monitor levels.
• Respiratory Depression: Rare with high doses; monitor in vulnerable patients.
• Peripheral Neuropathy: Prolonged use may cause numbness; assess regularly.
• Photosensitivity: Rare skin reaction to sunlight; use protection.
• Bone Marrow Suppression: Rare leukopenia or thrombocytopenia; monitor blood counts.

Use in Specific Populations

• Pregnancy: Category D; avoid unless critical; monitor fetus for hearing issues.
• Breastfeeding: Excreted in breast milk; monitor infant for effects.
• Elderly: Higher risk of toxicity; start with lower doses.
• Children: Limited to 3 months+; supervise closely.
• Renal/Hepatic Impairment: Adjust dose; avoid in severe cases.

Additional Precautions

• Inform your doctor about kidney disease, hearing issues, or medication history before starting this medication.
• Avoid concurrent use with other ototoxic or nephrotoxic drugs.

8. Overdose and Management of Streptomycin

Overdose Symptoms

Overdose may cause:

• Hearing loss, vertigo, or tinnitus.
• Severe cases: Acute kidney injury, neuromuscular blockade, or respiratory failure.
• Nausea, weakness, or dizziness as early signs.
• Seizures with extremely high doses.

Immediate Actions

• Contact the Medical Team: Seek immediate medical help.
• Supportive Care: Administer IV fluids, monitor vital signs, and correct electrolytes; use hemodialysis if needed.
• Specific Treatment: No antidote; manage symptoms and support respiration if blocked.
• Monitor: Check renal function, audiometry, and neuromuscular status for 48–72 hours.

Additional Notes

• Overdose risk is moderate; store securely.
• Report persistent symptoms (e.g., hearing loss, severe fatigue) promptly.

9. Side Effects of Streptomycin

Common Side Effects

• Ototoxicity (10–20%, monitor hearing)
• Nephrotoxicity (5–15%, transient with hydration)
• Nausea (5–10%, manageable with food)
• Vertigo (3–8%, reduces with dose adjustment)
• Rash (2–6%, mild and reversible)
  These effects may subside with dose adjustment or discontinuation.

Serious Side Effects

Seek immediate medical attention for:

• Auditory: Permanent hearing loss or vestibular damage.
• Renal: Acute kidney injury or oliguria.
• Neuromuscular: Respiratory paralysis or weakness.
• Allergic: Anaphylaxis or severe rash.
• Hematologic: Leukopenia or thrombocytopenia.

Additional Notes

• Regular monitoring for auditory function, renal parameters, and blood counts is advised.
• Report any unusual symptoms (e.g., tinnitus, reduced urine) immediately to a healthcare provider.

10. Drug Interactions with Streptomycin

This active ingredient may interact with:

• Ototoxic Drugs: Enhances toxicity (e.g., furosemide, cisplatin); avoid combinations.
• Nephrotoxic Drugs: Increases kidney damage (e.g., vancomycin); monitor closely.
• Neuromuscular Blockers: Potentiates effects (e.g., succinylcholine); use cautiously.
• Diuretics: Alters excretion (e.g., ethacrynic acid); adjust dose.
• Anticoagulants: Rare effect on bleeding; monitor INR.

Action: Provide your healthcare provider with a complete list of medications.

11. Patient Education or Lifestyle

• Medication Adherence: Take this aminoglycoside as prescribed for TB or infections, following the exact schedule.
• Monitoring: Report hearing changes, dizziness, or reduced urine immediately.
• Lifestyle: Avoid loud noises; stay hydrated.
• Diet: Take with or without food; avoid dehydration.
• Emergency Awareness: Know signs of kidney failure or hearing loss; seek care if present.
• Follow-Up: Schedule regular check-ups every 1–2 weeks to monitor renal function, hearing, and treatment response.

12. Pharmacokinetics of Streptomycin

• Absorption: Poor oral bioavailability; administered IM or IV (peak at 1–2 hours post-IM).
• Distribution: Volume of distribution ~0.25 L/kg; 34% protein-bound, penetrates poorly into CSF.
• Metabolism: Minimal hepatic metabolism; excreted unchanged.
• Excretion: Primarily renal (90%) via glomerular filtration; half-life 2–3 hours (prolonged in renal impairment).
• Half-Life: 2–3 hours, extended to 24–48 hours in renal failure.

13. Pharmacodynamics of Streptomycin

This drug exerts its effects by:

• Binding irreversibly to the 30S ribosomal subunit, inhibiting bacterial protein synthesis.
• Exhibiting bactericidal activity against aerobic Gram-negative bacilli and Mycobacterium tuberculosis.
• Demonstrating concentration-dependent killing, with post-antibiotic effects enhancing efficacy.
• Exhibiting dose-dependent ototoxicity and nephrotoxicity risks.

14. Storage of Streptomycin

• Temperature: Store at 20–25°C (68–77°F) or 2–8°C (36–46°F) if unopened; protect from light.
• Protection: Keep in original container, away from moisture.
• Safety: Store in a locked container out of reach of children due to toxicity risk.
• Disposal: Dispose of unused vials per hazardous drug regulations or consult a pharmacist.

15. Frequently Asked Questions (FAQs) About Streptomycin

Q: What does Streptomycin treat?
A: This medication treats tuberculosis and certain bacterial infections.

Q: Can this active ingredient cause hearing loss?
A: Yes, hearing loss may occur; report tinnitus or vertigo.

Q: Is Streptomycin safe for children?
A: Yes, for 3 months+ with a doctor’s guidance.

Q: How is this drug taken?
A: Via IM injection or IV infusion, as directed.

Q: How long is Streptomycin treatment?
A: 6–24 months for TB, depending on resistance.

Q: Can I use Streptomycin if pregnant?
A: No, avoid unless critical; consult a doctor.

16. Regulatory Information for Streptomycin

This medication is approved by:

• U.S. Food and Drug Administration (FDA): Approved in the 1940s for TB and bacterial infections.
• European Medicines Agency (EMA): Approved for TB and specific infections.
• Other Agencies: Approved globally for TB and rare infections; consult local guidelines.

17. References

1. U.S. Food and Drug Administration (FDA). (2023). Streptomycin Sulfate Prescribing Information.
   • Official FDA documentation detailing the drug’s approved uses, dosage, and safety.
2. European Medicines Agency (EMA). (2023). Streptomycin Summary of Product Characteristics.
   • EMA’s comprehensive information on the medication’s indications and precautions in Europe.
3. National Institutes of Health (NIH). (2023). Streptomycin: MedlinePlus Drug Information.
   • NIH resource providing detailed information on the drug’s uses, side effects, and precautions.
4. World Health Organization (WHO). (2023). WHO Guidelines on Tuberculosis Treatment: Streptomycin.
   • WHO’s recommendations for Streptomycin in TB therapy.
5. Antimicrobial Agents and Chemotherapy. (2022). Streptomycin in MDR-TB Management.
   • Peer-reviewed article on Streptomycin efficacy (note: access may require a subscription).