Streptomycin: Difference between revisions

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==General==
==General==
*Type: [[Aminoglycosides]]
*Type: [[Is DrugClass::Aminoglycoside]]
*Dosage Forms:  
*Dosage Forms:  
**IM
**IM
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===Infections, Bacterial===
===Infections, Bacterial===
*1-2 g/day IM divided q6-12h
*1-2 g/day IM divided q6-12h
** Max: 2 g/day; Info: adjust dose based on serum levels
**Max: 2 g/day; Info: adjust dose based on serum levels
**Renal dosing
***Creatinine Clearance 50-80: give q24h
***Creatinine Clearance 10-50: give q24-72h
***Creatinine Clearance <10: give q72-96h


===Active tuberclosis===
===Active [[tuberculosis]]===
*15 mg/kg IM q24h 5-7x/wk
*15mg/kg IM q24h 5-7x/wk
**Alternative: 25-30 mg/kg IM 2-3x/wk
**Alternative: 25-30mg/kg IM 2-3x/wk
 
===[[Plague]]===
*1g IM q12h x10 days
**Maximum dose: 2 g/day (adjust dose based on serum levels)
 
===[[Tularemia]]===
*1g IM q12h x10 days
**Maximum dose: 2 g/day (adjust dose based on serum levels)


==Pediatric Dosing==
==Pediatric Dosing==
'''All: Adjust repeat doses based on serum levels'''


===General (<7 Days Old)===
===Infections, Bacterial===
*'''<1.2kg'''
*20-40mg/kg IM q24h
**15 mg/kg IV q24h
**Alternative: 20-40mg/kg IM 2x/wk
**First Dose: 15 mg/kg IV x 1
**Maximum dose: 1 g/dose if q24h, or 1.5 g/dose if 2x/wk
*'''1.2-2kg'''
**Renal dosing
**10-15 mg/kg IV q12-18h
***Creatinine Clearance 50-80: 7.5mg/kg give q24h
**First Dose: 10-15 mg/kg IV x 1
***Creatinine Clearance 10-50: 7.5mg/kg give q24-72h
*'''>2.1kg'''
***Creatinine Clearance <10: 7.5mg/kg give q72-96h
**10-15 mg/kg IV q8-12h
**First Dose: 10-15 mg/kg IV x 1


===General (7 Days - 1 Month Old)===
===Active [[tuberculosis]]===
*'''<1.2kg'''
*20-40mg/kg IM q24h
**15 mg/kg IV q24h
**Alternative: 20-40mg/kg IM 2x/wk
**First Dose: 15 mg/kg IV x 1
**Maximum dose: 1 g/dose if q24h, or 1.5 g/dose if 2x/wk
*'''1.2-2kg'''
**10-15 mg/kg IV q8-12h
**First Dose: 10-15 mg/kg IV x 1
*'''>2.1kg'''
**15-20 mg/kg IV q8
**First Dose: 15-20 mg/kg IV x 1


===General (1 Month - 11 Years)===
===[[Plague]]===
*10-15 mg/kg IV q6-8h
*15mg/kg IM q12h x10 days
*First Dose: 10-15 mg/kg IV x 1
**Maximum dose: 2 g/day (adjust dose based on serum levels)
*Max: 1 gram per dose


===General (12 - 16 Years)===
===[[Tularemia]]===
*1000 mg IV q12h
*15mg/kg IM q12h x10 days
*First Dose: 1000mg IV x 1
**Maximum dose: 2 g/day (adjust dose based on serum levels)
*Alt: 10-15 mg/kg IV q12
*Info: Repeat dosing may require up to 1200-1500mg IV q12h or 10 mg/kg IV q8


===[[Clostridium Difficile]]===
==Special Populations==
*40 mg/kg/day PO divided q6-8h x 7-10 days
*[[Pregnancy Rating]]: D
*First Dose: 10-13 mg/kg x 1
*Lactation: Probably Safe
*Max 500mg/dose, 2000mg/day
*Monitoring parameters:
*For severe infection or recurrence
**BUN/creatinine at baseline, then periodically.
*May use in combination with metronidazole PO
**Serum drug levels
 
**Urinanalysis
===Staphylococcal Enterocolitis===
**Audiometry for high risk patients
*40 mg/kg/day PO divided q6-8h x 7-10 days
*First Dose: 10-13 mg/kg x 1
*Max 500mg/dose, 2000mg/day


===Community-Acquired [[Pneumonia (Peds)|Pneumonia]]===
==Contraindications / Cautions==
*40 mg/kg/day PO divided q6-8h x 10-14 days
*First Dose: 10-13 mg/kg x 1
*Info: Switch to appropriate oral regiment when possible


==Special Populations==
*Contraindicated:
*Pregnancy: C
**BCG live intravesical
*Lactation: Probably safe
**[[Cidofovir]]
*Renal Dosing
**[[Streptozocin]]
**Adult
***CrCl 50-90: 15mg/kg x1, then usual dose q12-24h
***CrCl 10-50: 15mg/kg x1, then usual dose q24h-96h
***CrCl <10: 15mg/kg x1, then usual dose q4-7 days
***Hemodialysis: Give supplement only if high-flux dialyzer used
***Peritoneal dialysis: No supplement
**Pediatric
***CrCl 10-50: give q18-48h
***CrCl <10: give q48-96h
***Hemodialysis: Give supplement only if high-flux dialyzer used
***Peritoneal dialysis: No supplement
*Hepatic Dosing (Adult & Pediatric)
**Not defined


==Contraindications==
*caution if hypersensitivity to sulfites
*Allergy to class/drug
*caution if impaired vestibular function
*caution if impaired auditory function
*caution if concurrent ototoxic agents
*caution if concurrent neurotoxic agents
*caution if neuromuscular disease
*caution if renal impairment
*caution if dehydration
*caution if concurrent nephrotoxic agent use
*caution if electrolyte abnormalities
*caution if prolonged use
*caution in neonates or infants
*caution in elderly patients


==Adverse Reactions==
==Adverse Reactions==
===Serious===
===Serious===
*Ototoxicity, auditory & vestibular
*Neurotoxicity
*Neuromuscular blockade
*Nephrotoxicity
*Anemia, hemolytic
*Pancytopenia
*[[Thrombocytopenia]]
*[[Anaphylaxis]]
*[[Anaphylaxis]]
*Severe [[hypotension]] (rapid IV use)
*Angioedema
*Thrombophlebitis
*Hypersensitivity reaction
*Tissue necrosis (if extravasation)
*vasculitis
*Exfoliative dermatitis
*Exfoliative dermatitis
*[[Stevens-Johnson Syndrome]]
*[[Toxic Epidermal Necrolysis]]
*Drug rash with eosinophilia and systemic symptoms
*Interstitial nephritis
*Nephrotoxicity
*Ototoxicity
*Neutropenia
*[[Thrombocytopenia]]
*Superinfection
*Superinfection
*[[Clostridium difficile]]


===Common===
===Common===
*Red Man Syndrome (rapid IV use)
*[[Nausea and vomiting]]
*Hypotension (rapid IV use)
*[[Vertigo]]
*Paresthesia, facial
*[[Rash]]
*[[Fever]]
*[[Fever]]
*[[Nausea]]
*[[Urticaria]]
*rigors
*[[Angioedema]]
*Eosinophilia
*Eosinophilia
*[[Rash]]
*Deafness
*[[Urticaria]]
*Exfoliative dermatitis
*Phlebitis
*[[Anaphylaxis]]
*Tinnitus
*Azotemia
*[[Dizziness]]/[[Vertigo]]
*Leukopenia
*Elevated BUN/Creatinine
*Thrombocytopenia
*[[Vomiting]] (PO use)
*Pancytopenia
*Flatulence (PO use)
*[[Anemia]], hemolytic
*muscle weakness
*Amblyopia
*Injection site reaction


==Pharmacology==
==Pharmacology==
*Half-life: 4-6h (7.5 days ESRD)
*Half-life: 5 hours
*Metabolism: CYP450
*Metabolism: Unknown; CYP450
*Excretion:
*Excretion: Urine
**IV route: Urine
*Mechanism of Action: Bactericidal (binds to 30S ribosomal subunit, inhibiting protein synthesis)
**PO Route: Minimal systemic absorption unless intestinal inflammation or renal impairment
*Mechanism of Action: Bactericidal
 
==[[Antibiotic Sensitivities]]<ref>Sanford Guide to Antimicrobial Therapy 2014</ref>==
{| class="wikitable"
| align="center" style="background:#f0f0f0;"|'''Group'''
| align="center" style="background:#f0f0f0;"|'''Organism'''
| align="center" style="background:#f0f0f0;"|'''Sensitivity'''
|-
| Gram Positive||[[Strep. Group A, B, C, G]]||'''S'''
|-
| ||[[Strep. Pneumoniae]]||'''S'''
|-
| ||[[Viridans strep]]||X1
|-
| ||Strep. anginosus gp||X1
|-
| ||[[Enterococcus faecalis]]||'''S'''
|-
| ||[[Enterococcus faecium]]||I
|-
| ||[[MSSA]]||'''S'''
|-
| ||[[MRSA]]||'''S'''
|-
| ||[[CA-MRSA]]||'''S'''
|-
| ||[[Staph. Epidermidis]]||'''S'''
|-
| ||[[C. jeikeium]]||'''S'''
|-
| ||[[L. monocytogenes]]||'''S'''
|-
| Gram Negatives||[[N. gonorrhoeae]]||R
|-
| ||[[N. meningitidis]]||R
|-
| ||[[Moraxella catarrhalis]]||X1
|-
| ||[[H. influenzae]]||X1
|-
| ||[[E. coli]]||R
|-
| ||[[Klebsiella]] sp||R
|-
| ||E. coli/Klebsiella ESBL+||R
|-
| ||E coli/Klebsiella KPC+||R
|-
| ||[[Enterobacter]] sp, AmpC neg||R
|-
| ||[[Enterobacter]] sp, AmpC pos||R
|-
| ||[[Serratia]] sp||X1
|-
| ||Serratia marcescens||R
|-
| ||[[Salmonella]] sp||R
|-
| ||[[Shigella]] sp||R
|-
| ||[[Proteus mirabilis]]||X1
|-
| ||[[Proteus vulgaris]]||R
|-
| ||[[Providencia sp.]]||X1
|-
| ||[[Morganella sp.]]||X1
|-
| ||[[Citrobacter freundii]]||X1
|-
| ||[[Citrobacter diversus]]||X1
|-
| ||[[Citrobacter sp.]]||X1
|-
| ||[[Aeromonas sp]]||X1
|-
| ||[[Acinetobacter sp.]]||R
|-
| ||[[Pseudomonas aeruginosa]]||R
|-
| ||[[Burkholderia cepacia]]||R
|-
| ||[[Stenotrophomonas maltophilia]]||R
|-
| ||[[Yersinia enterocolitica]]||X1
|-
| ||[[Francisella tularensis]]||X1
|-
| ||[[Brucella sp.]]||R
|-
| ||[[Legionella sp.]]||X1
|-
| ||[[Pasteurella multocida]]||X1
|-
| ||[[Haemophilus ducreyi]]||R
|-
| ||[[Vibrio vulnificus]]||X1
|-
| Misc||[[Chlamydophila sp]]||X1
|-
| ||[[Mycoplasm pneumoniae]]||X1
|-
| ||[[Rickettsia sp]]||R
|-
| ||[[Mycobacterium avium]]||X1
|-
| Anaerobes||[[Actinomyces]]||'''S'''
|-
| ||[[Bacteroides fragilis]]||R
|-
| ||[[Prevotella melaninogenica]]||R
|-
| ||[[Clostridium difficile]]||'''S'''
|-
| ||[[Clostridium (not difficile)]]||'''S'''
|-
| ||[[Fusobacterium necrophorum]]||X1
|-
| ||[[Peptostreptococcus sp.]]||'''S'''
|}
 
===Key===
{{Template:Antibacterial Spectra Key}}


==See Also==
==See Also==
*[[Antibiotics (Main)]]
*[[Antibiotics (Main)]]


==Source==
==References==
*Epocrates
<references/>
Epocrates


[[Category:Drugs]]
[[Category:Pharmacology]]
[[Category:ID]]

Latest revision as of 15:12, 18 July 2025

General

Adult Dosing

Infections, Bacterial

  • 1-2 g/day IM divided q6-12h
    • Max: 2 g/day; Info: adjust dose based on serum levels
    • Renal dosing
      • Creatinine Clearance 50-80: give q24h
      • Creatinine Clearance 10-50: give q24-72h
      • Creatinine Clearance <10: give q72-96h

Active tuberculosis

  • 15mg/kg IM q24h 5-7x/wk
    • Alternative: 25-30mg/kg IM 2-3x/wk

Plague

  • 1g IM q12h x10 days
    • Maximum dose: 2 g/day (adjust dose based on serum levels)

Tularemia

  • 1g IM q12h x10 days
    • Maximum dose: 2 g/day (adjust dose based on serum levels)

Pediatric Dosing

Infections, Bacterial

  • 20-40mg/kg IM q24h
    • Alternative: 20-40mg/kg IM 2x/wk
    • Maximum dose: 1 g/dose if q24h, or 1.5 g/dose if 2x/wk
    • Renal dosing
      • Creatinine Clearance 50-80: 7.5mg/kg give q24h
      • Creatinine Clearance 10-50: 7.5mg/kg give q24-72h
      • Creatinine Clearance <10: 7.5mg/kg give q72-96h

Active tuberculosis

  • 20-40mg/kg IM q24h
    • Alternative: 20-40mg/kg IM 2x/wk
    • Maximum dose: 1 g/dose if q24h, or 1.5 g/dose if 2x/wk

Plague

  • 15mg/kg IM q12h x10 days
    • Maximum dose: 2 g/day (adjust dose based on serum levels)

Tularemia

  • 15mg/kg IM q12h x10 days
    • Maximum dose: 2 g/day (adjust dose based on serum levels)

Special Populations

  • Pregnancy Rating: D
  • Lactation: Probably Safe
  • Monitoring parameters:
    • BUN/creatinine at baseline, then periodically.
    • Serum drug levels
    • Urinanalysis
    • Audiometry for high risk patients

Contraindications / Cautions

  • caution if hypersensitivity to sulfites
  • caution if impaired vestibular function
  • caution if impaired auditory function
  • caution if concurrent ototoxic agents
  • caution if concurrent neurotoxic agents
  • caution if neuromuscular disease
  • caution if renal impairment
  • caution if dehydration
  • caution if concurrent nephrotoxic agent use
  • caution if electrolyte abnormalities
  • caution if prolonged use
  • caution in neonates or infants
  • caution in elderly patients

Adverse Reactions

Serious

  • Ototoxicity, auditory & vestibular
  • Neurotoxicity
  • Neuromuscular blockade
  • Nephrotoxicity
  • Anemia, hemolytic
  • Pancytopenia
  • Thrombocytopenia
  • Anaphylaxis
  • Angioedema
  • Hypersensitivity reaction
  • Exfoliative dermatitis
  • Superinfection

Common

Pharmacology

  • Half-life: 5 hours
  • Metabolism: Unknown; CYP450
  • Excretion: Urine
  • Mechanism of Action: Bactericidal (binds to 30S ribosomal subunit, inhibiting protein synthesis)

See Also

References

Epocrates

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