Streptomycin (S)

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    Update: January 2022

     

     

    Forms, strengths and route of administration

    • Powder for injection, in vial of 1 g streptomycin base, to be dissolved in 4 ml of water for injection, for IM injection
    • DO NOT ADMINISTER BY IV INJECTION.

    Dosage

    • Adolescent 30 kg and over and adult: 12 to 18 mg/kg once daily
    • Adult 60 years and over: 15 mg/kg 3 times a week 
    • Maximum dose: 1000 mg daily
    • Renal insufficiency: 12 to 15 mg/kg 2 or 3 times a week

     

    The daily doses take into account the displacement volume (see note below).

     

    Weight
    (kg)

    Daily dose
    (mg)

    Daily dose (ml) - IM injection
    (1 g in 4 ml of water for injection;
    final volume 4.83 ml; 207 mg/ml)
    5-29

    Not used in patients < 30 kg 
     

    30-33

    500

    2.4 ml

    34-40

    600

    2.8 ml

    41-45

    700

    3.4 ml

    46-50

    800

    4 ml

    51-70

    900

    4.4 ml

    > 70

    1000

    Entire volume

     

    Note: displacement volume
    Powders for injection are usually formulated such that after reconstitution the final content of the vial corresponds to an adult dose. Errors may occur when only part of the reconstituted solution is to be administered and no allowance is made for the displacement volume. The risk of error increases the greater the weight of the powder and the smaller the volume of solvent used.

    Contra-indications, adverse effects, precautions

    • Do not administer to children or adolescents under 30 kg and patients with allergy to aminoglycosides.
    • Streptomycin should only be used when no alternative is available, especially in children and adolescents under 18 years.
    • Administer with caution to patients 60 years and over or patients with renal, vestibular, auditory or severe hepatic impairment.
    • May cause:
      • ototoxicity, nephrotoxicity, electrolyte disturbances;
      • hypersensitivity reactions;
      • local pain after injection.
    • For the management of adverse effects, see Appendix 17.
    • Avoid or monitor combination with other ototoxic and/or nephrotoxic drugs (furosemide, amphotericin B, tenofovir, etc.).
    • Pregnancy: CONTRA-INDICATED
    • Breastfeeding: no contra-indication

    Monitoring

    • Symptomatic monitoring. 
    • Audiometry, serum creatinine and electrolytes (K, Ca, Mg).

    Patient instructions

    • Maintain a good fluid intake to limit renal problems.

    Remarks

    • Use a different site for each injection (absorption may be delayed if the same site is used repeatedly).

    Storage

     
    –  Below 25 °C
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