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. |
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 | Consult provider |
| 2nd trimester | Consult provider |
| 3rd trimester | Consult provider |
Clinical note
Other nephrotoxic or ototoxic drugs increase risk of toxicity Can cause ototoxicity and nephrotoxicity.
| Breastfeeding | Compatible with breastfeeding with caution. Minimal excretion into breast milk (M/P ratio ~0.5). American Academy of Pediatrics considers compatible, but monitor infant for diarrhea, rash, and potential for gut flora alteration. |
| 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. |
■ 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 other aminoglycosides","History of severe toxic reaction to streptomycin (e.g., ototoxicity, nephrotoxicity)","Myasthenia gravis (relative, due to risk of neuromuscular blockade)"]
| 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…
| 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. |