Streptomycin (S)

Therapeutic action

– Antibacterial (aminoglycoside) with bactericidal activity

Presentation

– Streptomycin sulfate, eq. 1 g base, vial of powder for injection, for IM injection. DO NOT ADMINISTER BY IV INJECTION.

Dosage

– Child over 30 kg and adult: 12 to 18 mg/kg once daily
– Maximum dose: 1000 mg daily
– Patient over 60 years: 500 to 750 mg once daily
– Patient with severe renal impairment: 12 to 15 mg/kg/dose, 2 or 3 times per week

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

Weight
(kg)

Daily dose
(mg)

Daily dose - 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
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 the displacement volume is ignored. The risk of error increases the greater the weight of the powder and the smaller the volume of solvent used. For example, when reconstituting capreomycin, the increase in volume due to the displacement value of the powder is 0.7 ml. Therefore if 2 ml of solvent are added to the vial of powder for injection, the final volume will be 2.7 ml and the final concentration 1 g in 2.7 ml, i.e. 390 mg/ml (and not 1 g in 2 ml or 500 mg/ml).

Contra-indications, adverse effects, precautions

– Do not administer to children under 30 kg and patients with history of allergy to an aminoglycoside.
– Administer with caution to patients over 60 years or with pre-existing renal, vestibular or auditory impairment.
– May cause:
• ototoxicity (vestibular and auditory toxicity), renal toxicity, electrolyte disturbances; rarely, hypersensitivity reactions;
• local pain after injection.
– For the management of adverse effects, see Appendix 10.
– Avoid or monitor combination with other ototoxic and/or nephrotoxic drugs (furosemide, amphotericin B, tenofovir, etc.).
Pregnancy: CONTRA-INDICATED. Use capreomycin if an injectable agent is required.
Breast-feeding: no contra-indication

Monitoring

– Symptomatic monitoring, in particular early detection of ototoxicity (dizziness, tinnitus or hearing loss)

Patient instructions

– Maintain a good fluid intake to limit renal problems.

Remarks

 Storage: below 25°C -  
Reconstituted solution can be kept 24 hours below 25°C and protected from light.