Streptomycin

Indications

Streptomycin is an aminoglycoside antibiotic given by injection. In people, it is used mainly as part of combination treatment for tuberculosis (TB), especially drug-resistant or re-treatment cases, and for some serious infections such as plague, tularaemia, brucellosis (with other antibiotics) and certain cases of bacterial endocarditis. Many products sold under this name, often combined with a Penicillin, are veterinary injections used in animals such as cattle, goats, sheep, poultry, dogs and cats for bacterial infections; these are for animal use only.

How It Works

Streptomycin enters bacteria and binds to their ribosomes, the part of the cell that makes proteins. This causes faulty proteins to be made and kills the bacteria. In veterinary combinations, the Penicillin part attacks the bacterial cell wall, so together they cover a wider range of bacteria.

Dosage and Administration

Human use: given only by a doctor or nurse as an injection into a muscle, at a dose based on body weight, age and kidney function, as prescribed. For TB it is always used with other anti-TB medicines and dosing is set by the TB programme or specialist. Veterinary use: dose, route and duration must follow the label or a veterinarian's instructions. Observe the stated withdrawal periods before the animal's meat or milk is used for human food. Veterinary products are not for human use.

Interactions

Using it with other medicines that can harm the kidneys or ears increases the risk of damage, for example other Aminoglycosides (Gentamicin, Amikacin), Vancomycin, Amphotericin B, Cisplatin, Cyclosporine, and strong diuretics such as Furosemide or Ethacrynic acid. It can strengthen the effect of muscle relaxants and anaesthetics, which may affect breathing.

Contraindications

Do not use if allergic to Streptomycin or other aminoglycosides. It is not used in pregnancy and should be avoided in people with myasthenia gravis. Veterinary Penicillin combinations should not be used in animals allergic to Penicillin, and are not for use in some small rodents such as guinea pigs and rabbits unless the vet advises.

Side Effects

The most important side effects are damage to the inner ear, causing dizziness, loss of balance, ringing in the ears (tinnitus) or hearing loss, which can be permanent, and kidney damage. Other effects include pain at the injection site, numbness or tingling around the mouth, rash, fever and allergic reactions. Rarely, it may weaken breathing muscles.

Get urgent medical help for ringing in the ears, hearing loss, severe dizziness or unsteadiness, reduced urine, swelling of the face or throat, difficulty breathing, or a severe rash. In animals, contact a vet if there is swelling, collapse, unsteadiness or signs of allergy after injection.

Pregnancy and Lactation

Streptomycin can cause permanent deafness in an unborn baby and should not be used in pregnancy. Small amounts pass into breast milk; use while breastfeeding only if the doctor advises and watch the baby for diarrhoea or thrush. In animals, use in pregnant or lactating animals only on a vet's advice.

Precautions and Warnings

Kidney function and hearing (and balance) should be checked before and during treatment, especially in older people, those with kidney disease or long courses. Drink enough fluids. Report any hearing or balance changes early. People handling veterinary products should avoid skin contact and accidental self-injection, especially if allergic to penicillins.

Overdose

Overdose may cause kidney damage, hearing and balance damage, and weakness of breathing muscles. Seek emergency medical (or veterinary) help; dialysis may help remove the drug.

Therapeutic Class

Aminoglycoside antibiotic (antitubercular); veterinary antibacterial (often with Penicillin).

Storage

Store as directed on the pack, usually below 25 to 30°C, dry and away from light (some solutions need refrigeration at 2 to 8°C). Keep out of the reach of children and away from food and animal feed.