STREPTOMYCIN SULFATE
Clinical safety rating: avoid
Positive evidence of fetus risks but benefits may outweigh risks in some cases
Aminoglycoside antibiotic that irreversibly binds to the 30S ribosomal subunit, inhibiting protein synthesis by causing misreading of mRNA and preventing initiation complex formation.
| Metabolism | Primarily excreted unchanged by glomerular filtration; minimal hepatic metabolism. |
| Excretion | Primarily renal excretion via glomerular filtration; 80-98% of the dose is excreted unchanged in urine within 24 hours. Minor biliary excretion (less than 1%). Fecal excretion is negligible. |
| Half-life | Terminal elimination half-life is 2-3 hours in patients with normal renal function. In anuria or severe renal impairment, half-life may extend to 50-100 hours. Neonates have a prolonged half-life of 5-10 hours due to immature renal function. |
| Protein binding | Approximately 30-35% bound to plasma proteins, primarily albumin. |
| Volume of Distribution | 0.25-0.3 L/kg, indicating distribution primarily into extracellular fluid. Increased in neonates and patients with edema; decreased in dehydration. |
| Bioavailability | Intramuscular: approximately 100% bioavailable. Intravenous: 100%. Oral: less than 1% due to poor gastrointestinal absorption; not used enterally for systemic infections. |
| Onset of Action | Intramuscular: peak serum concentrations attained within 1-2 hours; clinical effect begins within 2-4 hours. Intravenous: peak concentrations immediately after infusion; clinical effect within 1-2 hours. Oral: negligible absorption; not used systemically. |
| Duration of Action | Duration of action is approximately 8-12 hours for intramuscular administration, allowing once-daily dosing protocols. Accumulation occurs in renal impairment, prolonging duration. |
| Molecular Weight | 1457.39 |
Intramuscular: 15 mg/kg/day (max 1 g/day) divided every 12 hours; intraperitoneal: 1 g/dialysis cycle; intrathecal: 1 mg/kg/day.
| Dosage form | INJECTABLE |
| Renal impairment | CrCl 10-50 mL/min: 7.5 mg/kg every 24-72 hours; CrCl <10 mL/min: 7.5 mg/kg every 72-96 hours; hemodialysis: 7.5 mg/kg post-dialysis; peritoneal dialysis: 1 g per 6 L dialysate exchange. |
| Liver impairment | No specific adjustment recommended; monitor serum levels and renal function closely. |
| Pediatric use | Intramuscular: 15-20 mg/kg/day (max 1 g/day) divided every 12 hours; neonates: 10-15 mg/kg/day divided every 12 hours. |
| Geriatric use | Initial dose: 7.5 mg/kg/day; adjust based on renal function; monitor ototoxicity and nephrotoxicity closely. |
| 1st trimester | Avoid use due to risk of ototoxicity and nephrotoxicity in the fetus; known to cause congenital deafness. |
| 2nd trimester | Use only if clearly needed and no alternative; monitor fetal auditory and renal function. |
| 3rd trimester | Use only if clearly needed; risk of fetal ototoxicity and nephrotoxicity. |
Clinical note
Other nephrotoxic or ototoxic drugs increase risk of toxicity Can cause ototoxicity and nephrotoxicity.
| Placental transfer | Streptomycin crosses the placenta and achieves significant fetal serum concentrations; known to cause fetal ototoxicity. |
| Breastfeeding | Streptomycin is excreted into breast milk in low concentrations; however, because of potential for serious adverse reactions in nursing infants, such as ototoxicity and nephrotoxicity, caution is advised. Consider alternative agents. |
■ FDA Black Box Warning
Warning: Neurotoxicity (including ototoxicity, which may be irreversible), nephrotoxicity, and neuromuscular blockade. Risk ofotoxicity is greater in patients with renal impairment, pre-existing hearing loss, or those receiving high doses or prolonged therapy. Neuromuscular blockade may occur following rapid intravenous administration or in patients receiving anesthetics or neuromuscular blocking agents.
| Common Effects | Ototoxicity |
| Serious Effects |
Hypersensitivity to streptomycin or any aminoglycosideMyasthenia gravisSevere renal impairment (e.g., anuria, oliguria)
| Precautions | Monitor renal function (serum creatinine, BUN, urinalysis) and auditory function (audiometric testing) before and during therapy., Adjust dose in renal impairment to avoid accumulation and toxicity., Avoid concurrent use of other nephrotoxic or ototoxic drugs (e.g., loop diuretics, vancomycin, other aminoglycosides)., Neuromuscular blockade risk: use caution in patients with myasthenia gravis, hypocalcemia, or those receiving neuromuscular blocking agents., Pregnancy: may cause fetal harm (crosses placenta); use only if clearly needed. |
Loading safety data…
| Lactation Rating | L4 (Possibly Hazardous) |
| Teratogenic Risk | First trimester: Avoid due to theoretical risk of ototoxicity and nephrotoxicity, though human data limited. Second and third trimesters: Use only for serious infections; associated with bilateral congenital deafness (especially with prolonged or high-dose use) due to fetal ototoxicity. Risk of nephrotoxicity also documented. |
| Fetal Monitoring | Monitor maternal renal function (serum creatinine, BUN), audiometry (baseline and periodic), and serum drug levels (peak and trough). Fetal monitoring includes ultrasound assessment for growth and amniotic fluid volume; consider non-stress test in third trimester if prolonged therapy. |
| Fertility Effects | No known adverse effects on fertility in humans. Animal studies show no impairment. |
| Food/Dietary | No significant food interactions known. Avoid excessive alcohol consumption as it may exacerbate side effects like nausea. |
| Clinical Pearls | Monitor for ototoxicity (vestibular and cochlear) and nephrotoxicity; adjust dose based on renal function. Peak serum concentration for therapeutic efficacy: 20-30 mcg/mL for gram-negative infections; trough <5 mcg/mL. Avoid concurrent use with other ototoxic or nephrotoxic drugs like loop diuretics or other aminoglycosides. Intrathecal administration may be required for CNS infections. |
| Patient Advice | Report any hearing loss, ringing in ears, or dizziness immediately. · Stay well hydrated to reduce risk of kidney damage. · Complete the full course of therapy even if you feel better. · Inform your doctor if you have any history of kidney disease, hearing problems, or myasthenia gravis. · Avoid taking other medications without consulting your doctor, especially diuretics or other antibiotics. |