Tuberculosis, Bacterial endocarditis, Plague, Tularaemia, Brucellosis Hypersensitivity to streptomycin and other aminoglycosides.

Administration: Reconstitution: Add 4.2 mL, 3.2 mL, or 1.8 mL of sterile water for inj to prepare a soln containing approx 200 mg, 250 mg, or 400 mg, respectively, of streptomycin per mL. Adult Dose: Intramuscular Tuberculosis Adult: 15 mg/kg as a single dose daily. Max: 1 g daily. As part of intermittent regimen: 25-30 mg/kg 2-3 times wkly. Max: 1.5 g/dose. Bacterial endocarditis Adult: Streptococcal endocarditis: 1 g bid for 1 wk, then 500 mg bid for the 2nd wk. Enterococcal endocarditis: 1 g bid for 2 wk then 500 mg bid for 4 wk. Doses are given in combination w/ penicillin. Bacteraemia; Meningitis; Pneumonia ; Brucellosis; Urinary tract infections Adult: For concomitant use w/ other agents and as 2nd line agent: 1-2 g daily in divided doses 6-12 hrly. Max: 2 daily. Plague Adult: 2 g daily in 2 divided doses for a minimum of 10 days. Tularaemia Adult: 1-2 g daily in divided doses for 7-14 days until the patient is afebrile for 5-7 days. Child Dose: Child: Moderate to Severe Infections: IM usually 20–30 mg/kg/day, max 1 g/day q12h Intramuscular Tuberculosis Child: 20-40 mg/kg as a single dose daily. Max: 1 g daily. As part of intermittent regimen: 25-30 mg/kg 2-3 times wkly. Max: 1.5 g/dose. Bacterial endocarditis Child: Enterococcal endocarditis: 20-30 mg/kg daily in 2 divided doses, in combination w/ penicillin. Bacteraemia; Meningitis; Pneumonia ; Brucellosis; Urinary tract infections Child: 20-40 mg/kg daily in divided doses 6-12 hrly. Plague Child: 30 mg/kg daily in 2-3 divided doses. Max: 2 g daily. Tularaemia Child: 15 mg/kg bid for at least 10-14 days. Max: 2 g daily. Renal Dose: Renal Impairment Load: 1 g IM, THEN CrCl: 50-80 mL/min: 7.5 mg/kg IM q24hr CrCl: 10-50 mL/min: 7.5 mg/kg IM q24-72hr CrCl <10 mL/min: 7.5 mg/kg IM q72-96hr Hemodialysis: 50-75% of initial loading dose at end of dialysis period

H1-receptor blockers may mask early signs of ototoxicity. May reduce excretion of zalcitabine. May inhibit ?-galactosidase activity. Potentially Fatal: Potentiates nephrotoxicity produced by other aminoglycosides, vancomycin and some cephalosporins. Potentiates ototoxicity produced by other aminoglycosides, ethacrynic acid, mannitol, furosemide and other diuretics.

Hypersensitivity to streptomycin and other aminoglycosides.

Neurotoxic reactions (e.g. vestibular and cochlear function disturbance, optic nerve dysfunction, peripheral neuritis, arachnoiditis, encephalopathy); paraesthesia of face, rash, fever, angioneurotic oedema, eosinophilia; exfoliative dermatitis, azotemia, leucopenia, thrombocytopenia, pancytopenia, haemolytic anaemia, muscular weakness, amblyopia. Potentially Fatal: Resp paralysis from neuromuscular blockade, Clostridium difficile-associated diarrhoea, anaphylaxis; rarely, nephrotoxicity.

Precaution: Patient w/ neuromuscular disorders (e.g. myasthenia gravis), pre-existing vertigo, or hearing loss. Renal impairment. Elderly, childn. Pregnancy and lactation. Monitoring Parameters Monitor renal and auditory function.

Store between 15-30°C. Protect from light.

Aminoglycosides, Anti-Tubercular Antibiotics

Streptomycin is bactericidal which inhibits bacterial protein synthesis. Susceptible organisms include Mycobacterium tuberculosis, Pasteurella pestis, P.tularensis, Brucella, H.influenzae, H.ducreyi, Klebsiella pneumonia, Escherichia coli, Proteus spp., Aerobacter aerogenes, Streptococcus faecalis, and Streptococcus viridans.

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.