Streptomycin

General

• Type: Aminoglycosides
• Dosage Forms:
  • IM

Adult Dosing

Infections, Bacterial

• 1-2 g/day IM divided q6-12h
  • Max: 2 g/day; Info: adjust dose based on serum levels

Active tuberclosis

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

Pediatric Dosing

All: Adjust repeat doses based on serum levels

General (<7 Days Old)

• <1.2kg
  • 15 mg/kg IV q24h
  • First Dose: 15 mg/kg IV x 1
• 1.2-2kg
  • 10-15 mg/kg IV q12-18h
  • First Dose: 10-15 mg/kg IV x 1
• >2.1kg
  • 10-15 mg/kg IV q8-12h
  • First Dose: 10-15 mg/kg IV x 1

General (7 Days - 1 Month Old)

• <1.2kg
  • 15 mg/kg IV q24h
  • First Dose: 15 mg/kg IV x 1
• 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)

• 10-15 mg/kg IV q6-8h
• First Dose: 10-15 mg/kg IV x 1
• Max: 1 gram per dose

General (12 - 16 Years)

• 1000 mg IV q12h
• First Dose: 1000mg IV x 1
• 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

• 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
• For severe infection or recurrence
• May use in combination with metronidazole PO

Staphylococcal Enterocolitis

• 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

• 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

• Pregnancy: C
• Lactation: Probably safe
• Renal Dosing
  • 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

• Allergy to class/drug

Adverse Reactions

Serious

• Anaphylaxis
• Severe hypotension (rapid IV use)
• Thrombophlebitis
• Tissue necrosis (if extravasation)
• vasculitis
• Exfoliative dermatitis
• Stevens-Johnson Syndrome
• Toxic Epidermal Necrolysis
• Drug rash with eosinophilia and systemic symptoms
• Interstitial nephritis
• Nephrotoxicity
• Ototoxicity
• Neutropenia
• Thrombocytopenia
• Superinfection
• Clostridium difficile

Common

• Red Man Syndrome (rapid IV use)
• Hypotension (rapid IV use)
• Fever
• Nausea
• rigors
• Eosinophilia
• Rash
• Urticaria
• Phlebitis
• Tinnitus
• Dizziness/Vertigo
• Elevated BUN/Creatinine
• Vomiting (PO use)
• Flatulence (PO use)

Pharmacology

• Half-life: 4-6h (7.5 days ESRD)
• Metabolism: CYP450
• Excretion:
  • IV route: Urine
  • PO Route: Minimal systemic absorption unless intestinal inflammation or renal impairment
• Mechanism of Action: Bactericidal

Antibiotic Sensitivities

Group	Organism	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

• S susceptible/sensitive (usually)
• I intermediate (variably susceptible/resistant)
• R resistant (or not effective clinically)
• S+ synergistic with cell wall antibiotics
• U sensitive for UTI only (non systemic infection)
• X1 no data
• X2 active in vitro, but not used clinically
• X3 active in vitro, but not clinically effective for Group A strep pharyngitis or infections due to E. faecalis
• X4 active in vitro, but not clinically effective for strep pneumonia

See Also

• Antibiotics (Main)

Source

• Epocrates