Streptomycin

General

• Type: Aminoglycosides
• Dosage Forms:
  • IM

Adult Dosing

Infections, Bacterial

• 1-2 g/day IM divided q6-12h
  • Max: 2 g/day; Info: adjust dose based on serum levels
  • Renal dosing
    • Creatinine Clearance 50-80: give q24h
    • Creatinine Clearance 10-50: give q24-72h
    • Creatinine Clearance <10: give q72-96h

Active tuberculosis

• 15mg/kg IM q24h 5-7x/wk
  • Alternative: 25-30mg/kg IM 2-3x/wk

Plague

• 1g IM q12h x10 days
  • Maximum dose: 2 g/day (adjust dose based on serum levels)

Tularemia

• 1g IM q12h x10 days
  • Maximum dose: 2 g/day (adjust dose based on serum levels)

Pediatric Dosing

Infections, Bacterial

• 20-40mg/kg IM q24h
  • Alternative: 20-40mg/kg IM 2x/wk
  • Maximum dose: 1 g/dose if q24h, or 1.5 g/dose if 2x/wk
  • Renal dosing
    • Creatinine Clearance 50-80: 7.5mg/kg give q24h
    • Creatinine Clearance 10-50: 7.5mg/kg give q24-72h
    • Creatinine Clearance <10: 7.5mg/kg give q72-96h

Active tuberculosis

• 20-40mg/kg IM q24h
  • Alternative: 20-40mg/kg IM 2x/wk
  • Maximum dose: 1 g/dose if q24h, or 1.5 g/dose if 2x/wk

Plague

• 15mg/kg IM q12h x10 days
  • Maximum dose: 2 g/day (adjust dose based on serum levels)

Tularemia

• 15mg/kg IM q12h x10 days
  • Maximum dose: 2 g/day (adjust dose based on serum levels)

Special Populations

• Pregnancy Rating: D
• Lactation: Probably Safe
• Monitoring parameters:
  • BUN/creatinine at baseline, then periodically.
  • Serum drug levels
  • Urinanalysis
  • Audiometry for high risk patients

Contraindications / Cautions

• Contraindicated:
  • BCG live intravesical
  • Cidofovir
  • Streptozocin

• caution if hypersensitivity to sulfites
• caution if impaired vestibular function
• caution if impaired auditory function
• caution if concurrent ototoxic agents
• caution if concurrent neurotoxic agents
• caution if neuromuscular disease
• caution if renal impairment
• caution if dehydration
• caution if concurrent nephrotoxic agent use
• caution if electrolyte abnormalities
• caution if prolonged use
• caution in neonates or infants
• caution in elderly patients

Adverse Reactions

Serious

• Ototoxicity, auditory & vestibular
• Neurotoxicity
• Neuromuscular blockade
• Nephrotoxicity
• Anemia, hemolytic
• Pancytopenia
• Thrombocytopenia
• Anaphylaxis
• Angioedema
• Hypersensitivity reaction
• Exfoliative dermatitis
• Superinfection

Common

• Nausea and vomiting
• Vertigo
• Paresthesia, facial
• Rash
• Fever
• Urticaria
• Angioedema
• Eosinophilia
• Deafness
• Exfoliative dermatitis
• Anaphylaxis
• Azotemia
• Leukopenia
• Thrombocytopenia
• Pancytopenia
• Anemia, hemolytic
• muscle weakness
• Amblyopia
• Injection site reaction

Pharmacology

• Half-life: 5 hours
• Metabolism: Unknown; CYP450
• Excretion: Urine
• Mechanism of Action: Bactericidal (binds to 30S ribosomal subunit, inhibiting protein synthesis)

See Also

• Antibiotics (Main)

References

Epocrates

Authors

Bobak Zonnoor, Neil Young, Daniel Ostermayer