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Streptomycin: Drug information

Streptomycin: Drug information
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For additional information see "Streptomycin: Patient drug information" and "Streptomycin: Pediatric drug information"

For abbreviations, symbols, and age group definitions show table
ALERT: US Boxed Warning
Toxicity:

The risk of severe neurotoxic reactions is sharply increased in patients with impaired renal function or prerenal azotemia. These include disturbances of vestibular and cochlear function, optic nerve dysfunction, peripheral neuritis, arachnoiditis, and encephalopathy. The incidence of clinically detectable, irreversible vestibular damage is particularly high in patients treated with streptomycin.

Renal function should be monitored carefully; patients with renal impairment and/or nitrogen retention should receive reduced doses. The peak serum concentration in individuals with kidney damage should not exceed 20 to 25 mcg/mL.

The concurrent or sequential use of other neurotoxic and/or nephrotoxic drugs with streptomycin, including neomycin, kanamycin, gentamicin, cephaloridine, paromomycin, viomycin, polymyxin B, colistin, tobramycin, and cyclosporine should be avoided.

The neurotoxicity of streptomycin can result in respiratory paralysis from neuromuscular blockage, especially when the drug is given soon after the use of anesthesia or muscle relaxants.

The administration of streptomycin in parenteral form should be reserved for patients where adequate laboratory and audiometric testing facilities are available during therapy.

Brand Names: Canada
  • Streptomycin
Pharmacologic Category
  • Antibiotic, Aminoglycoside;
  • Antitubercular Agent
Dosing: Adult

Note: Route of administration: Manufacturer’s labeling states for IM administration only; however, IV administration (off-label route) has been described (Ref).

Aminoglycoside dosing weight: For patients who are underweight (ie, total body weight [TBW] < ideal body weight [IBW]), calculate the dose based on TBW. For patients without obesity (ie, TBW 1 to 1.25 × IBW), calculate the dose based on TBW or IBW. TBW may be preferred in patients without obesity who may have increased volume of distribution (eg, critically ill). For patients with obesity (ie, TBW > 1.25 × IBW), calculate the dose based on adjusted body weight (IBW + [0.4 × (TBW-IBW)]) (Ref). Therapeutic drug monitoring: Monitoring of serum concentrations is recommended to ensure efficacy and avoid toxicity; confirm availability of rapid streptomycin serum concentrations. Timing and frequency of concentration monitoring is individualized based on dosing and monitoring strategy (Ref).

Usual dosage range: IM, IV: 15 to 30 mg/kg/day or 1 to 2 g daily.

Brucellosis

Brucellosis: IM, IV: 1 g once daily in combination with doxycycline. Duration depends on extent of disease; streptomycin is usually given for the first 14 to 21 days of therapy, followed by doxycycline monotherapy (Ref). Note: Additional agents or other regimens are preferred for neurobrucellosis, endocarditis, and infection in pregnant women (Ref).

Endocarditis

Endocarditis (alternate agent):

Enterococcus spp. (native or prosthetic valve, susceptible to penicillin and streptomycin/resistant to gentamicin): IM, IV: 7.5 mg/kg every 12 hours in combination with ampicillin or penicillin; Duration of therapy: 4 weeks (native valve and symptoms present <3 months); ≥6 weeks (native valve and symptoms present ≥3 months or prosthetic valve). Note: For native valve endocarditis due to ampicillin-susceptible E. faecalis, a combination regimen that does not contain streptomycin is preferred (Ref).

Mycobacterium avium complex infection

Mycobacterium avium complex infection (off-label use):

Disseminated disease in patients with HIV (alternative agent) (adjunctive agent): IM, IV: 1 g once daily as part of an appropriate combination regimen. Duration is variable depending on response and immunologic recovery. Note: Some experts recommend adding adjunctive agents (eg, streptomycin) to standard combination therapy in patients with severe disease, high risk of mortality, risk for drug resistance (eg, after failure of M. avium complex [MAC] prophylaxis), CD4 count <50 cells/mm3, high mycobacterial loads (ie, >2 log CFU/mL of blood), or no effective antiretroviral therapy. Adjunctive agents other than streptomycin are preferred (Ref).

Pulmonary disease (severe nodular/bronchiectatic or cavitary disease) (adjunctive agent): IM, IV: 10 to 15 mg/kg once daily or 15 to 25 mg/kg 3 times weekly (Ref) or 10 to 15 mg/kg 3 times weekly (Ref) or 15 mg/kg once daily (usual maximum dose: 1 g) for 1 month then 15 mg/kg 3 times weekly (Ref). Give streptomycin as part of an appropriate combination regimen for the first 2 to 3 months of therapy (Ref). Note: For older adults or patients who require >6 months of parenteral therapy, some experts recommend empiric dose reduction (Ref).

Pulmonary disease (cavitary or severe bronchiectatic or acid-fast bacilli smear-positive respiratory samples) or systemic illness in patients with cystic fibrosis (adjunctive agent): IM, IV: 15 mg/kg once daily (maximum: 1 g daily) as part of an appropriate combination regimen (Ref).

Plague, treatment

Plague (Yersinia pestis), treatment:

Note: Consult public health officials for event-specific recommendations.

IM, IV: 1 g every 12 hours for 7 to 14 days and for at least a few days after clinical resolution (Ref).

Tuberculosis, drug resistant

Tuberculosis, drug resistant (alternative agent):

Note: Expert consultation for optimal regimen and duration of treatment is advised.

IM, IV: 15 mg/kg once daily or 25 mg/kg 3 times weekly as part of an appropriate combination regimen (Ref).

Tularemia

Tularemia : IM: 10 to 15 mg/kg every 12 hours (maximum daily dose: 2 g) for ≥7 to 10 days depending on severity (Ref).

Dosage adjustment for concomitant therapy: Significant drug interactions exist, requiring dose/frequency adjustment or avoidance. Consult drug interactions database for more information.

Dosing: Kidney Impairment: Adult

There are no dosage adjustments provided in the manufacturer’s labeling; however, the following adjustments have been recommended:

Aronoff 2007: Note: Recommendations are based on doses of 1 to 2 g every 6 to 12 hours (1 g once daily for tuberculosis):

CrCl >50 mL/minute: No dosage adjustment necessary.

CrCl 10 to 50 mL/minute: Administer every 24 to 72 hours.

CrCl <10 mL/minute: Administer every 72 to 96 hours.

End-stage renal disease (ESRD):

Intermittent hemodialysis (IHD): One-half the recommended dose administered after hemodialysis on dialysis days. Note: Dosing dependent on the assumption of 3 times weekly complete IHD sessions.

Peritoneal dialysis (PD): Administration via PD fluid: 20 to 40 mg/L (20 to 40 mcg/mL) of PD fluid.

CRRT: Administer every 24 to 72 hours; monitor levels. Note: Drug clearance is highly dependent on the method of renal replacement, filter type, and flow rate. Appropriate dosing requires close monitoring of pharmacologic response, signs of adverse reactions due to drug accumulation, as well as drug concentrations in relation to target trough (if appropriate).

ATS/CDC/IDSA [Nahid 2016]:

Tuberculosis:

CrCl ≥30 mL/minute: No dosage adjustment necessary.

CrCl <30 mL/minute: 15 mg/kg/dose 2 to 3 times weekly.

ESRD on IHD: 15 mg/kg/dose 2 to 3 times weekly. Give after dialysis if given on day of dialysis.

Dosing: Liver Impairment: Adult

There are no dosage adjustments provided in the manufacturer’s labeling.

Dosing: Older Adult

Dose reductions are recommended by the manufacturer in patients >60 years of age.

M. avium complex disease: IM/IV: 8 to 10 mg/kg 2 to 3 times weekly (maximum dose for >50 years of age: 500 mg) ((Ref) or 10 mg/kg once daily for the first month followed by 15 mg/kg 3 times weekly (maximum dose for >59 years of age: 750 mg) (Ref).

Dosing: Pediatric

(For additional information see "Streptomycin: Pediatric drug information")

Note: Initial dosing recommendations presented. Monitoring of serum concentrations is recommended to ensure efficacy and avoid toxicity.

Dosing consideration for obesity: In pediatric patients with obesity, consider use of adjusted body weight (IBW + 0.4[TBW – IBW]) to calculate initial dosage, based on experience with other aminoglycosides and in adult patients (Ref). Alternatively, adjusted body weight for aminoglycoside dosing may be calculated for patients who are obese using the equation 0.7 × TBW (Ref). With other aminoglycosides (gentamicin), fat-free mass has been used to calculate the initial dose in pediatric patients ≥2 years of age regardless of body habitus (Ref). Dosage should then be individualized based on serum concentration monitoring.

General dosing: Infants, Children, and Adolescents: IM, IV: 20 to 40 mg/kg/day in divided doses every 12 to 24 hours; maximum dose: 1,000 mg/dose (Ref).

Endocarditis, enterococcal

Endocarditis, enterococcal (alternative agent): Note: Though not included in current pediatric endocarditis guidelines, streptomycin has been recommended for consideration in enterococcal endocarditis for gentamicin-resistant isolates (Ref).

Infants, Children, and Adolescents: IM, IV: 20 to 30 mg/kg/day in divided doses every 12 hours as part of an appropriate combination regimen; maximum dose: 1,000 mg/dose (Ref). Duration should be at least 4 to 6 weeks depending on whether prosthetic material is involved and which concomitant agent is used (Ref).

Mycobacterial infection, nontuberculous

Mycobacterial infection, nontuberculous:

Buruli ulcers (Mycobacterium ulcerans infection): Limited data available: Infants, Children, and Adolescents: IM, IV: 15 mg/kg once daily; maximum dose: 1,000 mg/dose. Use as part of an appropriate combination regimen for 8 weeks (Ref).

Disseminated mycobacterium avium complex disease in patients with HIV (adjunctive agent): Note: May be used as the third or fourth drug in patients with CD4 count <50 cells/mm3, high mycobacterial loads (ie, >2 log colony-forming units/mL of blood), or in the absence of effective antiretroviral therapy (Ref).

Adolescents: IM, IV: 1,000 mg once daily as part of an appropriate combination regimen (Ref).

Pulmonary infection in patients with cystic fibrosis: Infants, Children, and Adolescents: IM, IV: 20 to 40 mg/kg/dose once daily as part of an appropriate combination regimen; maximum dose: 1,000 mg/dose. Overall treatment duration is ≥12 months after culture conversion. Note: When streptomycin is used, it is part of the initial, intensive phase of treatment; continuation phase may not include streptomycin depending on culture results (Ref).

Pulmonary infection in patients without cystic fibrosis: Infants, Children, and Adolescents: IM: 15 mg/kg/dose once daily as part of an appropriate combination regimen; after initial period, may decrease to 15 mg/kg/dose 3 times weekly; maximum dose: 1,000 mg/dose. Overall duration is ≥12 months after culture conversion (Ref).

Plague

Plague: Note: Consult public health officials for event-specific recommendations.

Infants, Children, and Adolescents: IM, IV: 30 mg/kg/day divided every 12 hours for 10 to 14 days; maximum dose: 1,000 mg/dose (Ref).

Tuberculosis disease [active tuberculosis]; drug resistant

Tuberculosis disease [active tuberculosis]; drug resistant (alternative agent): Note: Recommended only in patients in whom susceptibility is confirmed and when absolutely necessary (ie, a 5-drug regimen of more effective or less toxic medications is not possible); always use as part of an appropriate combination regimen. Duration should be individualized based on extent of disease, rapidity of culture conversion, clinical response, and toxicity (Ref).

Once-daily regimen:

Infants, Children, and Adolescents: IM, IV: 15 to 20 mg/kg/dose once daily; some experts recommend doses of 20 to 40 mg/kg/dose once daily; maximum dose: 1,000 mg/dose (Ref).

Twice-weekly regimen: Note: Once-daily therapy is typically preferred. Dosing modified from adult dosing and accounting for increased total body water (Ref).

Infants, Children, and Adolescents: IM, IV: 25 to 30 mg/kg/dose twice weekly (Ref).

Tuberculosis disease [active tuberculosis]; meningitis

Tuberculosis disease [active tuberculosis]; meningitis (alternative agent): Note: Shorter, more intensive regimens including ethionamide may be preferred (Ref).

Infants, Children, and Adolescents: IM, IV: 20 to 40 mg/kg/dose once daily; doses as low as 15 mg/kg/dose once daily have been recommended; maximum daily dose: 1,000 mg/day. Streptomycin may be discontinued once isolate is determined susceptible to first-line drugs (Ref).

Tularemia

Tularemia (alternative agent): Infants, Children, and Adolescents: IM: 30 to 40 mg/kg/day in divided doses every 12 hours for 10 days; maximum dose: 1,000 mg/dose. In mild illness, 5 to 7 days of therapy may be sufficient; longer courses may be necessary for severe disease (Ref).

Dosage adjustment for concomitant therapy: Significant drug interactions exist, requiring dose/frequency adjustment or avoidance. Consult drug interactions database for more information.

Dosing: Kidney Impairment: Pediatric

There are no adjustments provided in the manufacturer's labeling; however, the following adjustments have been recommended (Ref):

Infants, Children, and Adolescents: Note: Renally adjusted dose recommendations are based on doses of 20 to 40 mg/kg/day every 24 hours. Monitor serum concentrations.

GFR 30 to 50 mL/minute/1.73 m2: Administer 7.5 mg/kg/dose every 24 hours.

GFR 10 to 29 mL/minute/1.73 m2: Administer 7.5 mg/kg/dose every 48 hours.

GFR <10 mL/minute/1.73 m2: Administer 7.5 mg/kg/dose every 72 to 96 hours.

Intermittent hemodialysis (IHD): Administer 7.5 mg/kg/dose every 72 to 96 hours.

Peritoneal dialysis (PD): Administer 7.5 mg/kg/dose every 72 to 96 hours.

Continuous renal replacement therapy (CRRT): Administer every 24 hours; monitor levels. Note: Drug clearance is highly dependent on the method of renal replacement, filter type, and flow rate. Appropriate dosing requires close monitoring of pharmacologic response, signs of adverse reactions due to drug accumulation, as well as drug concentrations in relation to target trough (if appropriate).

Dosing: Liver Impairment: Pediatric

There are no adjustments provided in the manufacturer's labeling.

Adverse Reactions

The following adverse drug reactions and incidences are derived from product labeling unless otherwise specified.

Frequency not defined.

Cardiovascular: Hypotension

Central nervous system: Drug fever, facial paresthesia, headache, neurotoxicity

Dermatologic: Exfoliative dermatitis, skin rash, urticaria

Gastrointestinal: Nausea, vomiting

Genitourinary: Azotemia, nephrotoxicity

Hematologic & oncologic: Eosinophilia, hemolytic anemia, leukopenia, pancytopenia, thrombocytopenia

Hypersensitivity: Anaphylaxis, angioedema

Neuromuscular & skeletal: Arthralgia, tremor, weakness

Ophthalmic: Amblyopia

Otic: Auditory ototoxicity, vestibular ototoxicity

Respiratory: Dyspnea

<1%, postmarketing, and/or case reports: DRESS syndrome (drug reaction with eosinophilia and systemic symptoms), toxic epidermal necrolysis

Contraindications

Hypersensitivity to streptomycin, other aminoglycosides, or any component of the formulation

Warnings/Precautions

Concerns related to adverse effects:

• Neuromuscular blockade and respiratory paralysis: [US Boxed Warning]: May cause neuromuscular blockade and respiratory paralysis; especially when given soon after anesthesia or muscle relaxants.

• Neurotoxicity: [US Boxed Warning]: May cause neurotoxicity, including disturbances of vestibular and cochlear function, optic nerve dysfunction, peripheral neuritis, arachnoiditis, and encephalopathy; usual risk factors include pre-existing renal impairment, concomitant neuro-/nephrotoxic medications. Ototoxicity is proportional to the amount of drug given and the duration of treatment. Tinnitus or vertigo may be indications of vestibular injury and impending bilateral irreversible damage. Baseline and periodic caloric stimulation and audiometric tests are recommended with prolonged therapy. Discontinue treatment if signs of ototoxicity occur.

• Superinfection: Prolonged use may result in fungal or bacterial superinfection, including C. difficile-associated diarrhea (CDAD) and pseudomembranous colitis; CDAD has been observed >2 months postantibiotic treatment.

Disease-related concerns:

• Hearing impairment: Use with caution in patients with pre-existing vertigo, tinnitus, or hearing loss.

• Neuromuscular disorders: Use with caution in patients with neuromuscular disorders, including myasthenia gravis.

• Renal impairment: [US Boxed Warning]: May cause nephrotoxicity. Use with caution in patients with renal impairment; dose adjustment necessary in patients with renal impairment and/or nitrogen retention. Monitor renal function closely; peak serum concentrations should not surpass 20 to 25 mcg/mL in patients with renal impairment.

Special populations:

• Patients with genomic variants in MT-RNR1: Carriers of certain variants in the MT-RNR1 gene (eg, m.1555A>G) may be at increased risk for aminoglycoside-induced ototoxicity, including potentially significant hearing loss that may be irreversible, even when serum levels are within the normal range.

Concurrent drug therapy issues:

• Neurotoxic and/or nephrotoxic drugs: [US Boxed Warning]: Avoid concomitant or sequential use with other neurotoxic and/or nephrotoxic drugs (eg, neomycin, kanamycin, gentamicin, paromomycin, polymyxin B, colistin, tobramycin, cyclosporine).

Dosage form specific issues:

• Sulfite sensitivity: Some formulations may contain sodium metabisulfite; may cause allergic reactions including anaphylaxis or asthma exacerbations (some life-threatening) in susceptible patients.

Other warnings/precautions:

• Appropriate use: [US Boxed Warning]: Parenteral form should be used only where appropriate audiometric and laboratory testing facilities are available. IM injections should be administered in a large muscle well within the body to avoid peripheral nerve damage and local skin reactions.

Dosage Forms: US

Excipient information presented when available (limited, particularly for generics); consult specific product labeling.

Solution Reconstituted, Intramuscular [preservative free]:

Generic: 1 g (1 ea)

Generic Equivalent Available: US

Yes

Pricing: US

Solution (reconstituted) (Streptomycin Sulfate Intramuscular)

1 g (per each): $93.75

Disclaimer: A representative AWP (Average Wholesale Price) price or price range is provided as reference price only. A range is provided when more than one manufacturer's AWP price is available and uses the low and high price reported by the manufacturers to determine the range. The pricing data should be used for benchmarking purposes only, and as such should not be used alone to set or adjudicate any prices for reimbursement or purchasing functions or considered to be an exact price for a single product and/or manufacturer. Medi-Span expressly disclaims all warranties of any kind or nature, whether express or implied, and assumes no liability with respect to accuracy of price or price range data published in its solutions. In no event shall Medi-Span be liable for special, indirect, incidental, or consequential damages arising from use of price or price range data. Pricing data is updated monthly.

Dosage Forms: Canada

Excipient information presented when available (limited, particularly for generics); consult specific product labeling.

Solution Reconstituted, Intramuscular:

Generic: 1 g (5 mL)

Administration: Adult

IM: Inject deep IM into large muscle mass; midlateral thigh muscle or upper outer quadrant of buttocks; rotate injection sites.

IV (off-label route): After dilution in admixture, infuse over 30 to 60 minutes (Ref).

Administration: Pediatric

Parenteral:

IM: Inject deep IM into a large muscle mass appropriate for age; rotate injection sites.

IV: After further dilution, infuse over 30 to 60 minutes (Ref).

Use: Labeled Indications

Tuberculosis, drug-resistant: Treatment of tuberculosis, in combination with other appropriate antituberculosis agents, when the primary agents are contraindicated because of toxicity or intolerance.

Nontuberculosis infections: Treatment of infections caused by susceptible bacteria that are not amenable to therapy with less potentially toxic agents, including sensitive Yersinia pestis (plague); Francisella tularensis (tularemia); Brucella; Klebsiella granulomatis (donovanosis, granuloma inguinale); Haemophilus ducreyi (chancroid); Haemophilus influenzae (in respiratory, endocardial, and meningeal infections, concomitantly with another antibacterial agent); Klebsiella pneumoniae pneumonia (concomitantly with another antibacterial agent); Escherichia coli, Proteus spp., Klebsiella aerogenes (formerly Enterobacter aerogenes), K. pneumoniae, and Enterococcus faecalis in urinary tract infections; Streptococcus viridans; E. faecalis (in endocardial infections, concomitant with penicillin); and gram-negative bacillary bacteremia (concomitant with another antibacterial agent).

Use: Off-Label: Adult

Mycobacterium avium complex infection

Medication Safety Issues
Sound-alike/look-alike issues:

Streptomycin may be confused with streptozocin

Metabolism/Transport Effects

None known.

Drug Interactions

Note: Interacting drugs may not be individually listed below if they are part of a group interaction (eg, individual drugs within “CYP3A4 Inducers [Strong]” are NOT listed). For a complete list of drug interactions by individual drug name and detailed management recommendations, use the drug interactions program by clicking on the “Launch drug interactions program” link above.

Aminoglycosides: May increase nephrotoxic effects of Aminoglycosides. Aminoglycosides may increase neurotoxic effects of Aminoglycosides. Risk X: Avoid

Amphotericin B: May increase nephrotoxic effects of Aminoglycosides. Amphotericin B may increase neurotoxic effects of Aminoglycosides. Risk C: Monitor

Ataluren: May increase adverse/toxic effects of Aminoglycosides. Specifically, an increased risk of nephrotoxicity may occur with the concomitant use of ataluren and aminoglycosides. Risk X: Avoid

Bacillus clausii: Antibiotics may decrease therapeutic effects of Bacillus clausii. Management: Bacillus clausii should be taken in between antibiotic doses during concomitant therapy. Risk D: Consider Therapy Modification

Bacitracin (Systemic): Streptomycin may increase nephrotoxic effects of Bacitracin (Systemic). Risk X: Avoid

BCG (Intravesical): Antibiotics may decrease therapeutic effects of BCG (Intravesical). Risk X: Avoid

BCG Vaccine (Immunization): Antibiotics may decrease therapeutic effects of BCG Vaccine (Immunization). Risk C: Monitor

Bisphosphonate Derivatives: Aminoglycosides may increase hypocalcemic effects of Bisphosphonate Derivatives. Aminoglycosides may increase nephrotoxic effects of Bisphosphonate Derivatives. Risk C: Monitor

Botulinum Toxin-Containing Products: Aminoglycosides may increase neuromuscular-blocking effects of Botulinum Toxin-Containing Products. Risk C: Monitor

Capreomycin: May increase neuromuscular-blocking effects of Aminoglycosides. Risk C: Monitor

CARBOplatin: Aminoglycosides may increase ototoxic effects of CARBOplatin. Especially with higher doses of carboplatin. CARBOplatin may increase nephrotoxic effects of Aminoglycosides. Risk C: Monitor

Cephalosporins: May increase nephrotoxic effects of Aminoglycosides. Cephalosporins may decrease serum concentration of Aminoglycosides. Risk C: Monitor

Cholera Vaccine: Antibiotics may decrease therapeutic effects of Cholera Vaccine. Management: Avoid cholera vaccine in patients receiving systemic antibiotics, and within 14 days following the use of oral or parenteral antibiotics. Risk X: Avoid

CISplatin: May increase nephrotoxic effects of Aminoglycosides. CISplatin may increase neurotoxic effects of Aminoglycosides. Risk X: Avoid

Colistimethate: Aminoglycosides may increase nephrotoxic effects of Colistimethate. Aminoglycosides may increase neuromuscular-blocking effects of Colistimethate. Management: Avoid coadministration of colistimethate and aminoglycosides whenever possible due to the risk of nephrotoxicity and neuromuscular blockade. If coadministration cannot be avoided, monitor renal and neuromuscular function. Risk D: Consider Therapy Modification

Cyclizine: May increase ototoxic effects of Aminoglycosides. Risk C: Monitor

CycloSPORINE (Systemic): Aminoglycosides may increase nephrotoxic effects of CycloSPORINE (Systemic). Risk C: Monitor

Distigmine: Aminoglycosides may decrease therapeutic effects of Distigmine. Risk C: Monitor

Fecal Microbiota (Live) (Oral): May decrease therapeutic effects of Antibiotics. Risk X: Avoid

Fecal Microbiota (Live) (Rectal): Antibiotics may decrease therapeutic effects of Fecal Microbiota (Live) (Rectal). Risk X: Avoid

Foscarnet: May increase nephrotoxic effects of Aminoglycosides. Management: Avoid concomitant use of foscarnet and aminoglycoside antibiotics, unless the expected benefits of combined treatment outweigh the risks. If combined, monitor renal function closely. Risk D: Consider Therapy Modification

Immune Checkpoint Inhibitors (Anti-PD-1, -PD-L1, and -CTLA4 Therapies): Antibiotics may decrease therapeutic effects of Immune Checkpoint Inhibitors (Anti-PD-1, -PD-L1, and -CTLA4 Therapies). Risk C: Monitor

Lactobacillus and Estriol: Antibiotics may decrease therapeutic effects of Lactobacillus and Estriol. Risk C: Monitor

Loop Diuretics: May increase adverse/toxic effects of Aminoglycosides. Specifically, nephrotoxicity and ototoxicity. Risk C: Monitor

Mannitol (Systemic): May increase nephrotoxic effects of Aminoglycosides. Risk X: Avoid

Mecamylamine: Aminoglycosides may increase neuromuscular-blocking effects of Mecamylamine. Risk X: Avoid

Methoxyflurane: Aminoglycosides may increase nephrotoxic effects of Methoxyflurane. Risk X: Avoid

Mycophenolate: Antibiotics may decrease active metabolite exposure of Mycophenolate. Specifically, concentrations of mycophenolic acid (MPA) may be reduced. Risk C: Monitor

Netilmicin (Ophthalmic): Aminoglycosides may increase nephrotoxic effects of Netilmicin (Ophthalmic). Risk X: Avoid

Neuromuscular-Blocking Agents: Aminoglycosides may increase therapeutic effects of Neuromuscular-Blocking Agents. Risk C: Monitor

Nonsteroidal Anti-Inflammatory Agents: May decrease excretion of Aminoglycosides. Data only in premature infants. Risk C: Monitor

Oxatomide: May increase ototoxic effects of Aminoglycosides. Risk C: Monitor

Penicillins: May decrease serum concentration of Aminoglycosides. Primarily associated with extended spectrum penicillins, and patients with renal dysfunction. Risk C: Monitor

Polymyxin B: May increase nephrotoxic effects of Aminoglycosides. Polymyxin B may increase neurotoxic effects of Aminoglycosides. Risk X: Avoid

Sodium Picosulfate: Antibiotics may decrease therapeutic effects of Sodium Picosulfate. Management: Consider using an alternative product for bowel cleansing prior to a colonoscopy in patients who have recently used or are concurrently using an antibiotic. Risk D: Consider Therapy Modification

Tacrolimus (Systemic): Aminoglycosides may increase nephrotoxic effects of Tacrolimus (Systemic). Risk C: Monitor

Tenofovir Products: Aminoglycosides may increase serum concentration of Tenofovir Products. Tenofovir Products may increase serum concentration of Aminoglycosides. Risk C: Monitor

Typhoid Vaccine: Antibiotics may decrease therapeutic effects of Typhoid Vaccine. Only the live attenuated Ty21a strain is affected. Management: Avoid use of live attenuated typhoid vaccine (Ty21a) in patients being treated with systemic antibacterial agents. Postpone vaccination until 3 days after cessation of antibiotics and avoid starting antibiotics within 3 days of last vaccine dose. Risk D: Consider Therapy Modification

Vancomycin: May increase nephrotoxic effects of Aminoglycosides. Vancomycin may increase neurotoxic effects of Aminoglycosides. Management: Consider avoiding coadministration of aminoglycosides and vancomycin unless clinically indicated. If coadministered, monitor closely for signs of nephrotoxicity and neurotoxicity. Risk D: Consider Therapy Modification

Reproductive Considerations

Evaluate pregnancy status prior to treatment of multidrug resistant tuberculosis in patients who could become pregnant. Patients who could become pregnant should use effective contraception during treatment for multidrug resistant tuberculosis (Esmail 2018).

Pregnancy Considerations

Streptomycin crosses the placenta.

Streptomycin may cause fetal harm if administered to a pregnant patient. There are multiple reports of total irreversible bilateral congenital deafness in children whose mothers received streptomycin during pregnancy.

Streptomycin is approved for the treatment of tuberculosis (TB). TB disease (active TB) is associated with adverse fetal outcomes including intrauterine growth restriction, low birth weight, preterm birth, and perinatal death (Esmail 2018; Miele 2020) as well as adverse maternal outcomes, including increased risks for anemia and cesarean delivery. Placental transmission may rarely occur with active maternal disease (Miele 2020). The treatment of multidrug resistant TB in pregnant patients should be individualized; evidence to support a specific regimen is not available (ATS/CDC/ERS/IDSA [Nahid 2019]; WHO 2020). When second-line agents are needed for the treatment of multidrug resistant TB during pregnancy, aminoglycosides should be avoided when alternative agents are effective (ATS/CDC/ERS/IDSA [Nahid 2019]). Streptomycin is not the preferred agent when an aminoglycoside is required for the treatment of TB during pregnancy (HHS [OI adult] 2025).

Untreated plague (Yersinia pestis) infection in pregnant patients may result in hemorrhage (including postpartum hemorrhage), maternal and fetal death, preterm birth, and stillbirth. Limited data suggest maternal-fetal transmission of Y. pestis can occur if not treated. Pregnant patients should be treated for Y. pestis; parenteral antibiotics are preferred for initial treatment when otherwise appropriate. Streptomycin is an alternative aminoglycoside recommended for use (in combination with a fluroquinolone) for treating pregnant patients with bubonic, pharyngeal, pneumonic, or septicemic plague (CDC [Nelson 2021]).

Breastfeeding Considerations

Streptomycin is present in breast milk.

Aminoglycosides have poor oral bioavailability (Edson 1991), which may limit systemic absorption via breast milk.

Streptomycin is considered compatible with breastfeeding. In general, antibiotics that are present in breast milk may cause non-dose-related modification of bowel flora. Monitor infants for GI disturbances, such as thrush and diarrhea (WHO 2002). Patients with multidrug resistant tuberculosis and a sputum smear-positive test should avoid breastfeeding when possible (Esmail 2018).

Monitoring Parameters

Baseline and periodic hearing tests (audiograms), clinical assessment for vertigo and tinnitus, BUN, creatinine, serum electrolytes; serum drug concentrations should be monitored in all patients (ATS/CDC/ERS/IDSA [Nahid 2019]).

Reference Range

Therapeutic:

Peak: Daily dosing: 20 to 35 mcg/mL (35 to 45 mcg/mL for mycobacterial disease); Three times weekly dosing: 65 to 80 mcg/mL (AHA [Baddour 2015]; ATS/ERS/ESCMID/IDSA [Daley 2020]; BTS [Haworth 2017]; CFF/ECFS [Floto 2016]; Edson 1991; Peloquin 2004; Zhu 2001).

Trough: <5 mcg/mL (AHA [Baddour 2015]; BTS [Haworth 2017]; CFF/ECFS [Floto 2016]; Edson 1991; Zhu 2001).

Supratherapeutic: Trough: >10 mcg/mL.

Mechanism of Action

Inhibits bacterial protein synthesis by binding directly to the 30S ribosomal subunits causing faulty peptide sequence to form in the protein chain

Pharmacokinetics (Adult Data Unless Noted)

Absorption: Oral: Poorly absorbed; IM: Well absorbed.

Distribution: Distributes into most body tissues and fluids except the brain; small amounts enter the cerebrospinal fluid only with inflamed meninges.

Vd:

Neonates (GA ≥33 weeks, PNA 4 to 20 days): 0.24 to 0.44 L/kg (Herngren 1977).

Infants ≥6 months and Children: Mean range: 0.25 ± 0.02 to 0.29 ± 0.03 L/kg (Bolme 1988).

Protein binding: 34%.

Half-life elimination:

Neonates:

Preterm, PNA 1 to 3 days: Mean: 7 hours; range: 4 to 9.1 hours (Axline 1964).

Preterm and term (GA ≥33 weeks), PNA 4 to 20 days: 1.39 to 4.64 hours (Herngren 1977).

Infants ≥6 months and Children: Mean range: 1.69 ± 0.36 to 2.58 ± 0.44 hours (Bolme 1988).

Adults: ~2 to 4.7 hours; prolonged with renal impairment.

Time to peak: IM: Within 1 to 2 hours.

Excretion: Urine (29% to 89% as unchanged drug); small amount (1%) excreted in bile, saliva, sweat, and tears.

Pharmacokinetics: Additional Considerations (Adult Data Unless Noted)

Anti-infective considerations:

Parameters associated with efficacy: Gram-negative bacilli: Concentration dependent; associated with Cmax (peak)/minimum inhibitory concentration (MIC), goal: ≥8 to 10 (Abdul-Aziz 2020; Lacy 1998) or AUC24/MIC, goal: 30 to 50 (mild/moderate infection, patients who are immunocompetent) or 80 to 100 (severe infection) (Bland 2018; Craig 2011; Drusano 2007).

Expected drug exposure in normal renal function:

Cmax (peak): Adults:

IV: 14 mg/kg (range: 11 to 25 mg/kg) (30-minute infusion): 43.6 mg/L (range: 9 to 107 mg/L) (Zhu 2001).

IM: 18 mg/kg (range: 10 to 23 mg/kg): 42.6 mg/L (range: 2.9 to 85.2 mg/L) (Zhu 2001).

IM: 1 g: 25 to 50 mg/L (manufacturer's labeling).

AUC24: Adults:

IV: 14 mg/kg (range: 11 to 25 mg/kg) (30-minute infusion): 284 mg•hour/L (range: 124 to 680 mg•hour/L) (Zhu 2001).

IM: 18 mg/kg (range: 10 to 23 mg/kg): 264 mg•hour/L (range: 175 to 343 mg•hour/L) (Zhu 2001).

Parameters associated with toxicity: Nephrotoxicity is associated with high Cmin (trough) aminoglycoside concentrations leading to renal accumulation (Abdul-Aziz 2020; Bertino 1993; Rybak 1999; Verpooten 1989).

Postantibiotic effect: Bacterial killing continues after streptomycin concentration falls below the MIC of targeted pathogen and varies significantly based on the organism, duration of antimicrobial exposure, streptomycin concentration, and concomitant antimicrobial therapy:

E. faecalis/E. faecium (alone or in combination with ampicillin or vancomycin): ~0 to 2 hours (Fuursted 1987; Fuursted 1989).

Mycobacterium tuberculosis: 32.2 hours (range: 0.7 to 60.2 hours) (Chan 2001).

Brand Names: International
International Brand Names by Country
For country code abbreviations (show table)

  • (AE) United Arab Emirates: Streptomycin;
  • (AR) Argentina: Estreptomicina | Estreptomicina klonal | Estreptomicina richet;
  • (AU) Australia: Streptomycin;
  • (BD) Bangladesh: Streptomycin;
  • (BE) Belgium: Streptomycine sulfate pfizer;
  • (BG) Bulgaria: Streptomycin;
  • (BR) Brazil: Furp estreptomicina;
  • (CN) China: Streptomycin;
  • (CO) Colombia: Estreptomicina;
  • (CZ) Czech Republic: Strepto Fatol | Streptomycin;
  • (DE) Germany: Strepto Fatol | Strepto-Hefa | Streptomycin | Streptothenat;
  • (DO) Dominican Republic: Estreptomicina;
  • (EC) Ecuador: Estreptomicina | Estreptomicina Sulfate;
  • (EE) Estonia: Streptomycin | Streptomycin tzf | Streptomycine panpharma | Streptomycini sulfas;
  • (EG) Egypt: Streptomycin;
  • (ES) Spain: Estrepto P H | Estreptomicina normon | Neodualestrepto;
  • (FI) Finland: Streptomycin;
  • (FR) France: Streptomycine panpharm;
  • (GB) United Kingdom: Streptaquaine | Streptomycin;
  • (GR) Greece: Streptomycine;
  • (HK) Hong Kong: Streptomycin | Streptomycin sulphate;
  • (HU) Hungary: Streptomycin | Streptomycin egis;
  • (ID) Indonesia: Streptomycin | Streptomycin sulphate;
  • (IE) Ireland: Streptomycin | Streptomycin sulphate;
  • (IL) Israel: Streptomycin;
  • (IN) India: Ambistryn-s | Cipstryn | Streptobiotic | Streptomac | Streptomycin;
  • (IT) Italy: Streptomicina solfato;
  • (JP) Japan: Streptomycin sulfate daiichi | Streptomycin sulfate kyowa | Streptomycin sulfate nikken;
  • (KE) Kenya: Strepto 1 | Streptomycin | Streptomycin sulphate | Streptomycin sulphate reig jofre;
  • (LB) Lebanon: Streptomycine;
  • (LT) Lithuania: Ambistryn-s | Estreptomicina normon | Streptomycin | Streptomycin sulphate | Streptomycini sulfas;
  • (LV) Latvia: Streptomycin | Streptomycine;
  • (MA) Morocco: Streptomycine specia;
  • (MX) Mexico: Estreptomicina | Sulfestrep | Treptorim;
  • (MY) Malaysia: Streptin | Streptomycin | Streptomycin sulphate;
  • (NG) Nigeria: Everdestiny streptomycin sulphate;
  • (NO) Norway: Strepto Fatol;
  • (PE) Peru: Estreptomicina;
  • (PH) Philippines: Pharmawealth streptomycin | Septin;
  • (PK) Pakistan: Streptomycin;
  • (PL) Poland: Pan streptomycin | Streptomycin;
  • (PT) Portugal: Estreptomicin azev | Estreptomicina | Estreptomicina atral | Estreptomicina labesfal;
  • (RO) Romania: Streptomicina sulfat cristalizata;
  • (RU) Russian Federation: Streptomycin | Streptomycin kmp | Streptomycin sulph;
  • (SA) Saudi Arabia: Streptomycin;
  • (SG) Singapore: Streptomycin sulphate meiji;
  • (SI) Slovenia: Strepto Fatol | Strepto-Hefa;
  • (SK) Slovakia: Streptomycin;
  • (SR) Suriname: Streptomycine;
  • (TH) Thailand: Streptomycin | Streptomycin meiji | Streptomycin sulphate;
  • (TN) Tunisia: Streptomycine | Streptomycine panpharma;
  • (TR) Turkey: Strep | Streptomycine;
  • (TW) Taiwan: Streptomycin;
  • (UA) Ukraine: Streptomycin sulfa;
  • (UG) Uganda: Septocin | Ustrep;
  • (UY) Uruguay: Estreptomicina;
  • (ZA) South Africa: Novostrep | Solustrep | Streptomycin | Streptomycin sulphate;
  • (ZM) Zambia: Streptocin | Streptomycin | Streptomycin sulphate;
  • (ZW) Zimbabwe: Streptomycin sulphate
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