Streptomycin
General Information
Unlicensed Non-Formulary antimicrobial: Must be recommended/prescribed by a Micro/ID consultant or registrar.
AWaRe antibiotic classification: 'Other'. Use as per guidelines or Micro/ID advice.
Renal and hepatic impairment
Dose in renal impairment
|
Creatinine clearance (mL/min) |
Intravenous dose |
|
50-80 |
1g loading dose, then 7.5mg/kg every 24 hours. Dose according to levels |
|
10-49 |
1g loading dose, then 7.5mg/kg every 24-72 hours. Dose according to levels |
|
Less than 10 |
7.5mg/kg every 72-96 hours. Dose according to levels |
|
HD/HDF/High Flux/PD |
Dialysed; give 50-75% of the loading dose after each dialysis. |
Note: dose ranges use creatinine clearance, rather than eGFR.
Assess renal function before and during treatment.
Dose in hepatic impairment
No information available.
Pregnancy
Discuss with pharmacy. Avoid use unless potential benefits outweigh risks. There is a risk of auditory or vestibular nerve damage in the infant when aminoglycosides are used in the second and third trimesters of pregnancy.
Additional information
- Main adverse effects are nephrotoxicity and ototoxicity – common in patients with renal impairment and elderly (careful monitoring and dose reduction required).
- Avoid concomitant treatment with other potentially ototoxic or nephrotoxic drugs e.g. loop diuretics, aminoglycosides and tacrolimus
- Rashes are a common side effect of streptomycin.
- Peak (one hour post-dose) plasma level should be 15–40 mg/L; trough levels (pre-dose) should be less than 5mg/L (less than 1mg/L in renal impairment or in those over 50 years)
- Whenever possible, treatment should not exceed 7 days
References
- Package leaflet for Strepto-Fatol (Streptomycin sulphate 1g injection), FATOL Arzneimittel GmbH ; last updated September 2009
- The Renal Drug Database. Streptomycin. Accessed via renaldrugdatabase.com 26/03/18. Last updated 22/02/18