Streptomycin Injection 1g/VIAL

Streptomycin
Description:  Antibiotic, Aminoglycoside; Antitubercular Agent

“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.”

CSA NA – FDA Approved – REMS (N) – Can Ship

Streptomycin inhibits bacterial protein synthesis by binding directly to the 30S ribosomal subunits causing errors in the peptide sequence to form dysfunctional proteins.

Tuberculosis; Nontuberculosis infections

Before starting Streptomycin make sure your physician is aware of any allergies or medications you currently take, if you have hearing impairment, a neuromuscular disorder, renal impairment, are pregnant, or breastfeeding. Streptomycin use has been associated with rare but serious adverse events such as neuromuscular blockade, respiratory paralysis, neurotoxicity, and antibiotic resistant superinfection.

IM, IV (off-label): 15 to 30 mg/kg/day or 1 to 2 g daily.  Aminoglycoside dosing weight is calculated based off of total body weight and ideal body weight depending on patients body type.  Refer to product monograph for example calculations.

How to Take: Inject deep intramuscularly into large muscle mass such as the midlateral thigh muscle or upper buttocks.  Alternate injection site areas and rotate injection sites.  Store intact vials at 20°C to 25°C (68°F to 77°F) and protect from light. Reconstituted solution may be stored at room temperature for up to 1 week.  Manufacturer’s labeling states for IM administration only, but IV administration (off-label route) has been described.  Monitoring of serum concentrations is recommended to ensure efficacy and avoid toxicity.

Hypotension, drug fever, facial paresthesia, headache, neurotoxicity, exfoliative dermatitis, skin rash, urticaria, nausea, vomiting, azotemia, nephrotoxicity, eosinophilia, hemolytic anemia, leukopenia, pancytopenia, thrombocytopenia, anaphylaxis, angioedema, arthralgia, tremor, weakness, amblyopia, auditory ototoxicity, vestibular ototoxicity, dyspnea

Note the frequency of side effects has not been determined in clinical trials

1. What do I do if side effects are intolerable?
   If side effects are causing a lot of distress speak to your physician as soon as possible to discuss options.
2. Why would my physician prescribe a medication with such serious side effects?
   Bacterial resistance is becoming more of an issue and not all antibiotics work for all bacteria.  Certain antibiotics concentrate in different parts of the body which can also affect which ones work in which situations.  Your physician takes the most recent clinical guidelines and follows local resistance patterns to make evidence-based decisions that are reviewed and agreed upon by the medical community as to what agents should be used in which types of infections.  Your current medications, your allergies, age, cost of medication, side effects you experience from various antibiotics and many other factors will further complicate or limit which medications are appropriate.  This decision was not made lightly, however if you are concerned, ask your physician to clarify why they made their choice of antibiotic and they can let you know why this was the best option for this scenario.