STREPTOMYCIN

A major disadvantage and cause of failure of streptomycin therapy is the development of bacterial resistance especially when used over a long period. The addition of other anti-tubercular drugs reduce the speed with which bacteria become resistant to streptomycin. It is absorbed very well and rapidly from i.m and subcutaneous sites. Drug is distributed in all the extracellular fluids and about one third in plasma is bound to protein.

Indications

Plague, tuberculosis, tularaemia, sub-acute bacterial endocarditis, meningitis, brucellosis

Dosage

The single dose of streptomycin is usually 1 gm/day for 2 to 3 months in severe forms of tuberculosis, such as meningitis and disseminated disease, followed by 1 gm two to three times weekly for remainder period of treatment.

Contra-Indications

Diseases of ear, particularly suppurative otitis-media, labyrinthine disturbances

Special Precautions

Impaired liver or kidney function, premature infants, possibility of resistance, skin sensitisation and impairment of vestibular and auditory functions. Paediatrics: Contraindicated. Pregnancy: Contraindicated. Lactation: Contraindicated. Elderly: Reduced dose necessary.

Side Effects

Anaphylactic shock, nephrotoxicity, ototoxicity, skin-rash, fever, aplastic anaemia and agranulocytosis, ataxia, eosinophillia, optic nerve dysfunction.

Drug Interactions

Potentiates nephrotoxicity produced by other aminoglycosides, vancomycin and some cephalosporins. Potentiates ototoxicity produced by other aminoglycosides and ethacryanic acid. Plasma levels increased by indomethacin, H1 receptor blockers .Incompatible with acids and alkalies. Synergism with benzylpenicilline.