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ANTIINFECTIVES FOR SYSTEMIC USE › ANTIBACTERIALS FOR SYSTEMIC USE › AMINOGLYCOSIDE ANTIBACTERIALS › Streptomycins
streptoduocin
J01GA02
Forms & Strengths
- Combination injection: Streptomycin sulfate and Dihydrostreptomycin sulfate equivalent to 0.5 g each per vial
- Combination injection: Streptomycin sulfate and Dihydrostreptomycin sulfate equivalent to 1 g each per vial
Adult Dosing
- Tuberculosis: 1 g to 2 g intramuscularly daily or 2 to 3 times weekly as part of a multi-drug regimen
- Severe bacterial infections: 1 g to 2 g intramuscularly daily divided into 2 to 4 doses, adjusted based on renal function and susceptibility
Pediatric Dosing
- Tuberculosis/Severe infections: 20 mg/kg to 40 mg/kg intramuscularly once daily (maximum 1 g daily), used rarely due to high risk of irreversible ototoxicity
Indications
- Treatment of tuberculosis caused by Mycobacterium tuberculosis (historical/obsolete due to toxicity)
- Severe infections caused by susceptible gram-negative bacilli and enterococci when safer alternatives are ineffective
Mechanism of Action
- Bactericidal aminoglycoside combination
- Binds irreversibly to the 30S ribosomal subunit of susceptible bacteria, inhibiting protein synthesis and causing misreading of the genetic code
Contraindications
- Hypersensitivity to streptomycin, dihydrostreptomycin, or other aminoglycosides
- Pre-existing auditory nerve impairment (high risk of permanent bilateral deafness)
- Myasthenia gravis (due to neuromuscular blockade risk)
Adverse Reactions
- Severe permanent bilateral auditory and vestibular ototoxicity (particularly high with dihydrostreptomycin)
- Nephrotoxicity, ranging from mild proteinuria to acute tubular necrosis
- Neuromuscular blockade and respiratory paralysis, especially with rapid IV administration or concurrent neuromuscular blockers
- Pain and irritation at the injection site, hypersensitivity reactions, rash, and eosinophilia
Drug Interactions
- Potentiation of ototoxicity and nephrotoxicity with concomitant use of other aminoglycosides, vancomycin, polymyxins, or loop diuretics
- Enhanced neuromuscular blockade when administered with general anesthetics, muscle relaxants, or massive transfusions of citrate-anticoagulated blood
- Increased risk of renal dysfunction with nephrotoxic agents such as amphotericin B and cisplatin
Curated Content: Needs Vetting Before Put to Clinical Use