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Streptomycin
Overview
What is Streptomycin?
Streptomycin is a water-soluble aminoglycoside derived from . It is marketed as the sulfate salt of streptomycin. The chemical name of streptomycin sulfate is D-Streptamine, -2-deoxy-2-(methylamino)-α-L-glucopyranosyl-(1→2)--5-deoxy-3--formyl-α-L-lyxofuranosyl-(1→4)-
-bis(aminoiminomethyl)-,sulfate (2:3) (salt). The molecular formula for Streptomycin Sulfate is (CHNO) -3HSO and the molecular weight is 1457.41. It has the following structural formula:
Streptomycin for Injection USP, equivalent to 1 gram streptomycin /vial is supplied as a sterile nonpyrogenic lyophillized cake for intramuscular use after reconstitution. The lyophillized cake may reduce to a powder during shipping.
After reconstitution the pH range for Streptomycin for Injection USP should be between 4.5 and 7 in a solution containing 200 mg of streptomycin activity per mL.
*Each vial of Streptomycin for Injection contains streptomycin sulfate equivalent to 1 gram of streptomycin.
What does Streptomycin look like?
What are the available doses of Streptomycin?
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What should I talk to my health care provider before I take Streptomycin?
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How should I use Streptomycin?
Streptomycin is indicated for the treatment of individuals with moderate to severe infections caused by susceptibile strains of microorganisms in the specific conditions listed below:
To reduce the development of drug-resistant bacteria and maintain the effectiveness of streptomycin and other antibacterial drugs, streptomycin should be used only to treat or prevent infections that are proven or strongly suspected to be caused by susceptible bacteria. When culture and susceptibility information are available, they should be considered in selecting or modifying antibacterial therapy. In the absence of such data, local epidemiology and susceptibility patterns may contribute to the empiric selection of therapy.
What interacts with Streptomycin?
A history of clinically significant hypersensitivity to streptomycin is a contraindication to its use. Clinically significant hypersensitivity to other aminoglycosides may contraindicate the use of streptomycin because of the known cross-sensitivity of patients to drugs in this class.
What are the warnings of Streptomycin?
DOSING INSTRUCTIONS MUST BE FOLLOWED WITH CARE. WHEN THE APPROPRIATE INFUSION SETS ARE USED, THE CALCULATED DOSE WILL BE DELIVERED TO THE PATIENT, BECAUSE THE LOSS OF NITROGLYCERIN INJECTION SEEN WITH STANDARD PVC TUBING WILL BE AVOIDED. THE DOSAGES REPORTED IN PUBLISHED STUDIES UTILIZED GENERAL-USE PVC ADMINISTRATION SETS, AND RECOMMENDED DOSES BASED ON THIS EXPERIENCE WILL BE TOO HIGH WHEN THE LOW-ABSORBING INFUSION SETS ARE USED.
Ototoxicity: Both vestibular and auditory dysfunction can follow the administration of streptomycin. The degree of impairment is directly proportional to the dose and duration of streptomycin administration, to the age of the patient, to the level of renal function and to the amount of underlying existing auditory dysfunction. The ototoxic effects of the aminoglycosides, including streptomycin, are potentiated by the co-administration of ethacrynic acid, mannitol, furosemide and possibly other diuretics.
The vestibulotoxic potential of streptomycin exceeds that of its capacity for cochlear toxicity. Vestibular damage is heralded by headache, nausea, vomiting and disequilibrium. Early cochlear injury is demonstrated by the loss of high frequency hearing. Appropriate monitoring and early discontinuation of the drug may permit recovery prior to irreversible damage to the sensorineural cells.
Pregnancy: Streptomycin can cause fetal harm when administered to a pregnant woman. Because streptomycin readily crosses the placental barrier, caution in use of the drug is important to prevent ototoxicity in the fetus. If this drug is used during pregnancy, or if the patient becomes pregnant while taking this drug, the patient should be apprised of the potential hazard to the fetus.
C. produces toxins A and B which contribute to the development of CDAD. Hypertoxin producing strains of C. cause increased morbidity and mortality, as these infections can be refractory to antimicrobial therapy and may require colectomy. CDAD must be considered in all patients who present with diarrhea following antibiotic use. Careful medical history is necessary since CDAD has been reported to occur over two months after the administration of antibacterial agents.
If CDAD is suspected or confirmed, ongoing antibiotic use not directed against C. may need to be discontinued. Appropriate fluid and electrolyte management, protein supplementation, antibiotic treatment of C and surgical evaluation should be instituted as clinically indicated.
What are the precautions of Streptomycin?
General
Prescribing streptomycin in the absence of a proven or strongly suspected bacterial infection or a prophylactic indication is unlikely to provide benefit to the patient and increases the risk of the development of drug-resistant bacteria.
Baseline and periodic caloric stimulation tests and audiometric tests are advisable with extended streptomycin therapy. Tinnitus, roaring noises, or a sense of fullness in the ears indicates need for audiometric examination or termination of streptomycin therapy or both.
Care should be taken by individuals handling streptomycin for injection to avoid skin sensitivity reactions. As with all intramuscular preparations, Streptomycin Sulfate Injection should be injected well within the body of a relatively large muscle and care should be taken to minimize the possibility of damage to peripheral nerves. (See .)
Extreme caution must be exercised in selecting a dosage regimen in the presence of pre-existing renal insufficiency. In severely uremic patients a single dose may produce high blood levels for several days and the cumulative effect may produce ototoxic sequelae. When streptomycin must be given for prolonged periods of time alkalinization of the urine may minimize or prevent renal irritation.
A syndrome of apparent central nervous system depression, characterized by stupor and flaccidity, occasionally coma and deep respiratory depression, has been reported in very young infants in whom streptomycin dosage had exceeded the recommended limits. Thus, infants should not receive streptomycin in excess of the recommended dosage.
In the treatment of venereal infections such as granuloma inguinale, and chancroid, if concomitant syphilis is suspected, suitable laboratory procedures such as a dark field examination should be performed before the start of treatment, and monthly serologic tests should be done for at least four months.
As with other antibiotics, use of this drug may result in overgrowth of nonsusceptible organisms, including fungi. If superinfection occurs, appropriate therapy should be instituted.
Information for Patients
Patients should be counseled that antibacterial drugs including streptomycin should only be used to treat bacterial infections. They do not treat viral infections (e.g., the common cold). When streptomycin is prescribed to treat a bacterial infection, patients should be told that although it is common to feel better early in the course of therapy, the medication should be taken exactly as directed. Skipping doses or not completing the full course of therapy may (1) decrease the effectiveness of the immediate treatment and (2) increase the likelihood that bacteria will develop resistance and will not be treatable by streptomycin or other antibacterial drugs in the future.
Diarrhea is a common problem caused by antibiotics which usually ends when the antibiotic is discontinued. Sometimes after starting treatment with antibiotics, patients can develop watery and bloody stools (with or without stomach cramps and fever) even as late as two or more months after having taken the last dose ofthe antibiotic. If this occurs, patients should contact their physician as soon as possible.
Drug Interactions
The ototoxic effects of the aminoglycosides, including streptomycin, are potentiated by the co-administration of ethacrynic acid, furosemide, mannitol and possibly other diuretics.
Pregnancy
Category D: See section.
Nursing Mothers
Because of the potential for serious adverse reactions in nursing infants from streptomycin, a decision should be made whether to discontinue nursing or to discontinue the drug, taking into account the importance of the drug to the mother.
Pediatric Use
(See .)
What are the side effects of Streptomycin?
The following reactions are common: vestibular ototoxicity (nausea, vomiting, and vertigo); paresthesia of face; rash; fever; urticaria; angioneurotic edema; and eosinophilia.
The following reactions are less frequent: cochlear ototoxicity (deafness); exfoliative dermatitis; anaphylaxis; azotemia; leucopenia; thrombocytopenia; pancytopenia; hemolytic anemia; muscular weakness; and amblyopia.
Vestibular dysfunction resulting from the parenteral administration of streptomycin is cumulatively related to the total daily dose. When 1.8 to 2 g/day are given, symptoms are likely to develop in the large percentage of patients - especially in the elderly or patients with impaired renal function - within four weeks. Therefore, it is recommended that caloric and audiometric tests be done prior to, during, and following intensive therapy with streptomycin in order to facilitate detection of any vestibular dysfunction and/or impairment of hearing which may occur.
Vestibular symptoms generally appear early and usually are reversible with early detection and cessation of streptomycin administration. Two to three months after stopping the drug, gross vestibular symptoms usually disappear, except from the relative inability to walk in total darkness or on very rough terrain.
Although streptomycin is the least nephrotoxic of the aminoglycosides, nephrotoxicity does occur rarely.
Clinical judgment as to termination of therapy must be exercised when side effects occur.
What should I look out for while using Streptomycin?
A history of clinically significant hypersensitivity to streptomycin is a contraindication to its use. Clinically significant hypersensitivity to other aminoglycosides may contraindicate the use of streptomycin because of the known cross-sensitivity of patients to drugs in this class.
Ototoxicity: Both vestibular and auditory dysfunction can follow the administration of streptomycin. The degree of impairment is directly proportional to the dose and duration of streptomycin administration, to the age of the patient, to the level of renal function and to the amount of underlying existing auditory dysfunction. The ototoxic effects of the aminoglycosides, including streptomycin, are potentiated by the co-administration of ethacrynic acid, mannitol, furosemide and possibly other diuretics.
The vestibulotoxic potential of streptomycin exceeds that of its capacity for cochlear toxicity. Vestibular damage is heralded by headache, nausea, vomiting and disequilibrium. Early cochlear injury is demonstrated by the loss of high frequency hearing. Appropriate monitoring and early discontinuation of the drug may permit recovery prior to irreversible damage to the sensorineural cells.
Pregnancy: Streptomycin can cause fetal harm when administered to a pregnant woman. Because streptomycin readily crosses the placental barrier, caution in use of the drug is important to prevent ototoxicity in the fetus. If this drug is used during pregnancy, or if the patient becomes pregnant while taking this drug, the patient should be apprised of the potential hazard to the fetus.
Clostridium difficile
difficile.
C. produces toxins A and B which contribute to the development of CDAD. Hypertoxin producing strains of C. cause increased morbidity and mortality, as these infections can be refractory to antimicrobial therapy and may require colectomy. CDAD must be considered in all patients who present with diarrhea following antibiotic use. Careful medical history is necessary since CDAD has been reported to occur over two months after the administration of antibacterial agents.
If CDAD is suspected or confirmed, ongoing antibiotic use not directed against C. may need to be discontinued. Appropriate fluid and electrolyte management, protein supplementation, antibiotic treatment of C and surgical evaluation should be instituted as clinically indicated.
What might happen if I take too much Streptomycin?
Sorry No Records found
How should I store and handle Streptomycin?
Store at 20° to 25°C (68° to 77°F). [See USP Controlled Room Temperature.] Manufactured by:Carlsbad Technology, Inc.5922 Farnsworth Court Suite 102 Carlsbad, CA 92008Distributed by:McKesson Packaging Servicesa business unit of McKesson Corporation7101 Weddington Rd., Concord, NC 28027Repackaged By:Cardinal HealthZanesville, OH 43701L50720040715IS-4014571August 2014Store at 20° to 25°C (68° to 77°F). [See USP Controlled Room Temperature.] Manufactured by:Carlsbad Technology, Inc.5922 Farnsworth Court Suite 102 Carlsbad, CA 92008Distributed by:McKesson Packaging Servicesa business unit of McKesson Corporation7101 Weddington Rd., Concord, NC 28027Repackaged By:Cardinal HealthZanesville, OH 43701L50720040715IS-4014571August 2014Store at 20° to 25°C (68° to 77°F). [See USP Controlled Room Temperature.] Manufactured by:Carlsbad Technology, Inc.5922 Farnsworth Court Suite 102 Carlsbad, CA 92008Distributed by:McKesson Packaging Servicesa business unit of McKesson Corporation7101 Weddington Rd., Concord, NC 28027Repackaged By:Cardinal HealthZanesville, OH 43701L50720040715IS-4014571August 2014Store at 20° to 25°C (68° to 77°F). [See USP Controlled Room Temperature.] Manufactured by:Carlsbad Technology, Inc.5922 Farnsworth Court Suite 102 Carlsbad, CA 92008Distributed by:McKesson Packaging Servicesa business unit of McKesson Corporation7101 Weddington Rd., Concord, NC 28027Repackaged By:Cardinal HealthZanesville, OH 43701L50720040715IS-4014571August 2014Store at 20° to 25°C (68° to 77°F). [See USP Controlled Room Temperature.] Manufactured by:Carlsbad Technology, Inc.5922 Farnsworth Court Suite 102 Carlsbad, CA 92008Distributed by:McKesson Packaging Servicesa business unit of McKesson Corporation7101 Weddington Rd., Concord, NC 28027Repackaged By:Cardinal HealthZanesville, OH 43701L50720040715IS-4014571August 2014Store at 20° to 25°C (68° to 77°F). [See USP Controlled Room Temperature.] Manufactured by:Carlsbad Technology, Inc.5922 Farnsworth Court Suite 102 Carlsbad, CA 92008Distributed by:McKesson Packaging Servicesa business unit of McKesson Corporation7101 Weddington Rd., Concord, NC 28027Repackaged By:Cardinal HealthZanesville, OH 43701L50720040715IS-4014571August 2014Store at 20° to 25°C (68° to 77°F). [See USP Controlled Room Temperature.] Manufactured by:Carlsbad Technology, Inc.5922 Farnsworth Court Suite 102 Carlsbad, CA 92008Distributed by:McKesson Packaging Servicesa business unit of McKesson Corporation7101 Weddington Rd., Concord, NC 28027Repackaged By:Cardinal HealthZanesville, OH 43701L50720040715IS-4014571August 2014Store at 20° to 25°C (68° to 77°F). [See USP Controlled Room Temperature.] Manufactured by:Carlsbad Technology, Inc.5922 Farnsworth Court Suite 102 Carlsbad, CA 92008Distributed by:McKesson Packaging Servicesa business unit of McKesson Corporation7101 Weddington Rd., Concord, NC 28027Repackaged By:Cardinal HealthZanesville, OH 43701L50720040715IS-4014571August 2014Streptomycin for Injection USP is available in single vials containing 1 gram NDC 39822-0706-1 packaged as boxes of ten vials NDC 39822-0706-2.
Clinical Information
Chemical Structure
No Image foundClinical Pharmacology
Streptomycin sulfate is a bactericidal antibiotic. It acts by interfering with normal protein synthesis.
Streptomycin has been shown to be active against most strains of the following organisms both and in clinical infection. (See.):
Non-Clinical Toxicology
A history of clinically significant hypersensitivity to streptomycin is a contraindication to its use. Clinically significant hypersensitivity to other aminoglycosides may contraindicate the use of streptomycin because of the known cross-sensitivity of patients to drugs in this class.Ototoxicity: Both vestibular and auditory dysfunction can follow the administration of streptomycin. The degree of impairment is directly proportional to the dose and duration of streptomycin administration, to the age of the patient, to the level of renal function and to the amount of underlying existing auditory dysfunction. The ototoxic effects of the aminoglycosides, including streptomycin, are potentiated by the co-administration of ethacrynic acid, mannitol, furosemide and possibly other diuretics.
The vestibulotoxic potential of streptomycin exceeds that of its capacity for cochlear toxicity. Vestibular damage is heralded by headache, nausea, vomiting and disequilibrium. Early cochlear injury is demonstrated by the loss of high frequency hearing. Appropriate monitoring and early discontinuation of the drug may permit recovery prior to irreversible damage to the sensorineural cells.
Pregnancy: Streptomycin can cause fetal harm when administered to a pregnant woman. Because streptomycin readily crosses the placental barrier, caution in use of the drug is important to prevent ototoxicity in the fetus. If this drug is used during pregnancy, or if the patient becomes pregnant while taking this drug, the patient should be apprised of the potential hazard to the fetus.
Clostridium difficile
difficile.
C. produces toxins A and B which contribute to the development of CDAD. Hypertoxin producing strains of C. cause increased morbidity and mortality, as these infections can be refractory to antimicrobial therapy and may require colectomy. CDAD must be considered in all patients who present with diarrhea following antibiotic use. Careful medical history is necessary since CDAD has been reported to occur over two months after the administration of antibacterial agents.
If CDAD is suspected or confirmed, ongoing antibiotic use not directed against C. may need to be discontinued. Appropriate fluid and electrolyte management, protein supplementation, antibiotic treatment of C and surgical evaluation should be instituted as clinically indicated.
The ototoxic effects of the aminoglycosides, including streptomycin, are potentiated by the co-administration of ethacrynic acid, furosemide, mannitol and possibly other diuretics.
Prescribing streptomycin in the absence of a proven or strongly suspected bacterial infection or a prophylactic indication is unlikely to provide benefit to the patient and increases the risk of the development of drug-resistant bacteria.
Baseline and periodic caloric stimulation tests and audiometric tests are advisable with extended streptomycin therapy. Tinnitus, roaring noises, or a sense of fullness in the ears indicates need for audiometric examination or termination of streptomycin therapy or both.
Care should be taken by individuals handling streptomycin for injection to avoid skin sensitivity reactions. As with all intramuscular preparations, Streptomycin Sulfate Injection should be injected well within the body of a relatively large muscle and care should be taken to minimize the possibility of damage to peripheral nerves. (See .)
Extreme caution must be exercised in selecting a dosage regimen in the presence of pre-existing renal insufficiency. In severely uremic patients a single dose may produce high blood levels for several days and the cumulative effect may produce ototoxic sequelae. When streptomycin must be given for prolonged periods of time alkalinization of the urine may minimize or prevent renal irritation.
A syndrome of apparent central nervous system depression, characterized by stupor and flaccidity, occasionally coma and deep respiratory depression, has been reported in very young infants in whom streptomycin dosage had exceeded the recommended limits. Thus, infants should not receive streptomycin in excess of the recommended dosage.
In the treatment of venereal infections such as granuloma inguinale, and chancroid, if concomitant syphilis is suspected, suitable laboratory procedures such as a dark field examination should be performed before the start of treatment, and monthly serologic tests should be done for at least four months.
As with other antibiotics, use of this drug may result in overgrowth of nonsusceptible organisms, including fungi. If superinfection occurs, appropriate therapy should be instituted.
The following reactions are common: vestibular ototoxicity (nausea, vomiting, and vertigo); paresthesia of face; rash; fever; urticaria; angioneurotic edema; and eosinophilia.
The following reactions are less frequent: cochlear ototoxicity (deafness); exfoliative dermatitis; anaphylaxis; azotemia; leucopenia; thrombocytopenia; pancytopenia; hemolytic anemia; muscular weakness; and amblyopia.
Vestibular dysfunction resulting from the parenteral administration of streptomycin is cumulatively related to the total daily dose. When 1.8 to 2 g/day are given, symptoms are likely to develop in the large percentage of patients - especially in the elderly or patients with impaired renal function - within four weeks. Therefore, it is recommended that caloric and audiometric tests be done prior to, during, and following intensive therapy with streptomycin in order to facilitate detection of any vestibular dysfunction and/or impairment of hearing which may occur.
Vestibular symptoms generally appear early and usually are reversible with early detection and cessation of streptomycin administration. Two to three months after stopping the drug, gross vestibular symptoms usually disappear, except from the relative inability to walk in total darkness or on very rough terrain.
Although streptomycin is the least nephrotoxic of the aminoglycosides, nephrotoxicity does occur rarely.
Clinical judgment as to termination of therapy must be exercised when side effects occur.
Reference
This information is obtained from the National Institute of Health's Standard Packaging Label drug database.
"https://dailymed.nlm.nih.gov/dailymed/"
While we update our database periodically, we cannot guarantee it is always updated to the latest version.
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Interactions
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