Streptomycin

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Contents

Introduction

The first drug active against tuberculosis isolated in isolated in 1943. Its scarcity lead to a land mark trial [1] that not only revolutionised treatment but was the first true clinical randomised controlled trial[2] in the context of post war fair shares for all. It is rarely used now except for drug resistant tuberculosis and for vestibular ablation.

Clinical Use

Indications

Administration

IM 15mg/kg to max 1g daily with reduced dose if under 50kg, over 40 years or with renal impairment to total accumulative dose 100g

Clinical Issues

Class Contraindications

Class Side-effects

  • Ototoxicity
  • Nephrotoxicity
  • Impairment neuromuscular transmission

Aminoglycoside ototoxicity is associated with a genetic susceptibility in a third to a half of all cases. Most commonly mitochondrial – shows bacterial origin. Screening patients likely to need repeated courses eg CFs, chemotherapy patients, preterm neonates is feasible, but cost:benefit ratio? Consider costs of deafness, cochlear implant etc.

Class Interactions

  • Enhanced ototoxicity with ototoxic diuretics eg furosemide.

Special advice

Monitor drug levels in renal failure. Can cause hearing loss through exposure in pregnancy[3]

Pharmacology

Inhibits bacterial ribosomal protein formation.

References

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