Streptomycin

2024 Author: Rachel Wainwright | [email protected]. Last modified: 2023-12-15 07:39

Streptomycin: instructions for use and reviews

1. Release form and composition
2. Pharmacological properties
3. Indications for use
4. Contraindications
5. Method of application and dosage
6. Side effects
7. Overdose
8. Special instructions
9. Application during pregnancy and lactation
10. For violations of liver function
11. Drug interactions
12. Analogs
13. Terms and conditions of storage
14. Terms of dispensing from pharmacies
15. Reviews
16. Price in pharmacies

Latin name: Streptomycin

ATX code: J01GA01

Active ingredient: streptomycin (streptomycin)

Producer: JSC "Sintez", JSC "Pharmasintez", JSC "Biochemist" (Russia), "Kievmedpreparat" (Ukraine)

Description and photo update: 2019-16-08

Powder for preparation of solution for intramuscular administration Streptomycin

Streptomycin is a broad-spectrum antibiotic from the aminoglycoside group.

Release form and composition

The dosage form of Streptomycin is a powder for preparing a solution for intramuscular administration: crystalline, hygroscopic, almost white or white; solvent - water for injection: clear, colorless, odorless liquid [in bottles of 500 or 1000 mg, 1, 5, 10, 25, 50, 100 bottles in a cardboard box; solvent (if included): in polyethylene ampoules of 2 or 5 ml].

Active ingredient in 1 bottle: streptomycin - 500 or 1000 mg.

Pharmacological properties

Pharmacodynamics

Streptomycin is formed during the vital activity of the radiant fungi Streptomyces globisporus or other varieties of Streptomyces spp. This substance has a bacteriostatic effect in low concentrations. It consists in the fact that streptomycin penetrates the walls of the microbial cell and binds to specific receptor proteins on the 30S subunit of the bacterial ribosome. This prevents the formation of an initiating complex “messenger RNA + 30S ribosome subunit”, which activates the disintegration of polyribosomes. As a result, the reading of information from DNA is disrupted and defective proteins are produced, which at the final stage causes an arrest of the growth and development of microbial cells. In higher concentrations, streptomycin is characterized by a bactericidal effect,expressed in damage to the cytoplasmic membranes and subsequent death of the microbial cell.

Streptomycin has a broad spectrum of antimicrobial action. It is active against Mycobacterium tuberculosis, some gram-positive microorganisms (Corynebacterium diphtheriae, Staphylococcus spp.), Most gram-negative bacteria [Klebsiella spp. (including Klebsiella pneumoniae), Escherichia coli, Haemophilus influenzae, Haemophilus ducreyi, Proteus spp., Francisella tularensis, Salmonella spp., Brucella spp., Yersinia spp. (including Yersinia pestis), Shigella spp., Neisseria meningitidis, Neisseria gonorrhoeae].

Streptomycin demonstrates moderate activity against Enterococcus spp. and Streptococcus spp. (including Streptococcus pneumoniae). In combination with vancomycin or benzylpenicillin, streptomycin is effectively used in the therapy of endocarditis caused by Streptococcus viridians or Enterococcus faecalis.

Streptomycin is resistant in a weakly acidic environment, but the substance is easily destroyed in solutions of acids and alkalis when heated. Secondary resistance of harmful microorganisms to the drug develops quickly enough. Streptomycin has no effect on anaerobic bacteria, Pseudomonas aeruginosa, Rickettsia spp., Spirochaetaceae family.

Pharmacokinetics

When administered intramuscularly, streptomycin is rapidly and almost 100% absorbed from the injection site. The maximum concentration of the substance in the blood is reached within 30–90 minutes and is 25–50 μg / ml (after intramuscular injection of 1000 mg of the drug). Streptomycin binds to plasma proteins by less than 10% and is distributed in all body tissues (except brain tissue), including peritoneal, ascitic, lymphatic, synovial and pericardial fluids, pleural effusion, extracellular fluid and abscess fluid.

In high concentrations, the substance is determined in the lungs, liver, kidneys, and in bone and adipose tissue it is contained in small amounts. The volume of distribution in adult patients is 0.26 l / kg, in children - 0.2-0.4 l / kg, in newborns not older than 1 week and with a body weight of less than 1500 g - up to 0.68 l / kg, with a body weight of more than 1500 g - up to 0.58 l / kg, in patients with cystic fibrosis - 0.3–0.39 l / kg.

Streptomycin does not penetrate the intact blood-brain barrier, but it crosses the placental barrier and is determined in breast milk. The substance is not involved in metabolic processes.

The half-life in adults is 2–4 hours, in newborns - 5–8 hours, in older children - 2.5–4 hours. The terminal half-life exceeds 100 hours due to the gradual release of streptomycin from intracellular depots. In patients with renal insufficiency, the elimination half-life varies depending on the severity of the disease and can reach 100 hours. In patients with cystic fibrosis, this figure is 1–2 hours, and in patients with hyperthermia and burns, the half-life may be shortened compared to average values due to increased clearance. 95% of the streptomycin dose is excreted in the urine unchanged by glomerular filtration.

Indications for use

tuberculosis of various localization, including tuberculous meningitis (along with other drugs);
brucellosis, tularemia, plague;
venereal granuloma;
urinary tract infections, acute bacterial intestinal infections (after determining the sensitivity of the pathogen);
bacterial endocarditis (only in combination with vancomycin or benzylpenicillin).

Contraindications

Absolute:

severe chronic renal failure, occurring with uremia and azotemia;
organic lesions of the VIII pair of cranial nerves;
pregnancy;
hypersensitivity to the components of the drug, including a burdened history of individual intolerance to other aminoglycosides.

Relative (antibiotic Streptomycin is prescribed with caution in the presence of the following diseases / conditions):

botulism (therapy can lead to the development of disorders of neuromuscular transmission with further weakening of skeletal muscles);
parkinsonism;
myasthenia gravis;
obliterating endarteritis;
chronic renal failure (with creatinine clearance 40-60 ml / min);
heart failure II and III degree;
hearing disorders;
dehydration;
tendency to bleeding;
disorders of cerebral circulation;
children and old age;
period of breastfeeding.

Instructions for the use of Streptomycin: method and dosage

Streptomycin is administered intramuscularly.

Immediately before administration, the contents of the vial should be dissolved in sterile water for injection in a proportion of 500 mg / 2 ml or 1000 mg / 4 ml.

Recommended adult doses: single - 500-1000 mg, daily - from 1000 to 2000 (maximum) mg. In case of poor tolerance, with a body weight of up to 50 kg and patients over 60 years of age, 750 mg of Streptomycin is prescribed per day.

Recommended daily doses for children:

up to 3 months: 10 mg / kg;
3-6 months: 15 mg / kg;
6 months to 2 years: 20 mg / kg;
up to 13 years old and older: 15–20 mg / kg (children under 13 years old - up to 500 mg, adolescents - up to 1000 mg).

Maximum doses (single / daily):

3-4 years: 150/300 mg;
5-6 years: 175/350 mg;
7-9 years: 200/400 mg;
9-14 years: 250/500 mg;
from 14 years old: 500/1000 mg.

The scheme of drug use:

tuberculosis of the lungs and other organs: 15 mg / kg (but not more than 1000 mg) per day in 1 or (with poor tolerance) 2 doses; course - from 3 months in combination with other anti-tuberculosis drugs;
tularemia: 2 times a day, 500–1000 mg; course - 1-2 weeks before the 5-7th day of the absence of febrile temperature;
bacterial endocarditis of streptococcal genesis (caused by Streptococcus spp., exhibiting sensitivity to penicillin): the first 7 days - 2 times a day, 1000 mg, the next 7 days - 2 times a day, 500 mg; a single dose for patients over 60 years of age throughout the treatment - 500 mg; course - 2 weeks in combination with benzylpenicillin;
bacterial endocarditis of enterococcal genesis: the first 14 days - 2 times a day, 1000 mg, the next 28 days - 2 times a day, 500 mg; course - 6 weeks in combination with benzylpenicillin (duration may be reduced due to ototoxicity);
plague, brucellosis: 2 times a day, 1000 mg; course - from 7 to 10 days.

In the treatment of venereal granuloma, urinary tract infections and acute bacterial intestinal infections, the daily dose should be divided into 2–4 injections; the duration of the course is from 10 to 14 days.

In patients with renal insufficiency, the daily dose of Streptomycin is reduced. Maximum daily dose depending on creatinine clearance:

50-60 ml / min: 500 mg;
40-50 ml / min: 400 mg.

The initial daily dose for arterial hypertension and coronary heart disease is 250 mg, its increase is possible in case of good tolerance.

Side effects

urinary system: nephrotoxicity (nausea, a significant decrease or increase in the frequency of urination, anorexia, oliguria, thirst, polyuria, vomiting);
nervous system: drowsiness, headache, peripheral neuritis, weakness, neuritis of the facial nerve (tingling, numbness, burning sensation in the mouth or face area), neuromuscular blockade when administered in combination with muscle relaxants (sleep apnea, difficulty breathing, respiratory arrest), neurotoxic effect (paresthesia, muscle twitching, epileptic seizures);
digestive system: nausea, diarrhea, vomiting, liver functional disorders (hyperbilirubinemia, increased activity of hepatic transaminases);
allergic reactions: rash, itching, angioedema, flushing of the skin, fever;
sense organs: ototoxicity (ringing, hearing loss, hearing loss up to irreversible deafness, a feeling of stuffiness in the ears or buzzing), labyrinth / vestibular disorders (vomiting, discoordination, nausea, dizziness, instability);
local reactions: pain / hyperemia at the injection site.

In cases where any of the described violations are aggravated, or the development of any other adverse reactions not indicated in the instructions is noted, you need to consult a specialist.

Overdose

The most important symptoms of an overdose of Streptomycin are toxic reactions, which are expressed in nausea, vomiting, hearing loss, ringing or a feeling of stuffiness in the ears, anorexia, ataxia, dizziness, thirst, urination disorders, and respiratory failure until it stops.

In this case, it is necessary to eliminate the blockade of neuromuscular transmission and its consequences, for which the intake of calcium salts and cholinesterase inhibitors is prescribed, hemodialysis or peritoneal dialysis is performed, and if necessary, artificial ventilation is used. Other symptomatic and supportive therapies are also helpful.

special instructions

Since the antibiotic Streptomycin can mask the symptoms of syphilis, if a mixed infection is possible for 4 months, a serological test should be performed monthly.

During therapy, at least 1 time in 7 days, it is necessary to monitor the function of the vestibular apparatus and the auditory nerve. If the result of audiometric tests is unsatisfactory, you should reduce the dose of the drug, or interrupt treatment.

With impaired renal function, the likelihood of nephrotoxicity is higher. An increased risk is also observed with the appointment of the drug in high doses or with a long course (for this category of patients, daily monitoring of renal function may be required). On average, kidney function should be monitored at least once every 7 days.

The use of Streptomycin contributes to a change in the normal intestinal flora with an increase in the growth of Clostridium difficile, which can lead to the development of prolonged diarrhea of varying severity, abdominal pain, fever, intoxication (in the form of weakness, weakness, nausea, vomiting), the appearance of leukocytosis (in the form of an increase the number of leukocytes in the blood). Such symptoms can develop both during the course and 7-14 days after discontinuation of Streptomycin. It is impossible to use drugs that inhibit intestinal peristalsis.

For children under 1 year old, the appointment of the drug is possible only for health reasons.

In the absence of positive clinical dynamics, Streptomycin is canceled. It is necessary to take into account the likelihood of the occurrence of resistant microorganisms (if necessary, the drug is canceled and appropriate therapy is prescribed).

During the period of using Streptomycin when driving vehicles, mechanisms and performing other potentially hazardous types of work that require patients to have psychomotor speed and increased concentration of attention, care must be taken.

Application during pregnancy and lactation

According to the instructions, Streptomycin is contraindicated during pregnancy, since it penetrates the placental barrier, exerting an ototoxic and nephrotoxic effect on the fetus. During lactation, the drug is used with caution (streptomycin is found in breast milk in low concentrations and is poorly absorbed from the gastrointestinal tract).

For violations of liver function

Patients with impaired liver function require a daily dose adjustment.

Drug interactions

Mixing Streptomycin solution with cephalosporins and antibiotics of the penicillin series in one syringe is unacceptable.

With the combined use of Streptomycin with certain drugs / substances, the following effects may develop:

beta-lactam antibiotics (penicillins, cephalosporins): synergistic action;
other oto- and nephrotoxic drugs (including other polymyxins, aminoglycosides, capreomycin): an increase in the likelihood of developing oto- and nephrotoxic effects;
methoxyflurane: an increase in the likelihood of side reactions of streptomycin;
anti-myasthenic drugs: a decrease in their effectiveness;
indomethacin (intravenous): a decrease in the renal clearance of streptomycin, an increase in its concentration in the blood and an increase in the half-life;
opioid analgesics, drugs for inhalation anesthesia (halogenated hydrocarbons), transfusion of large amounts of blood with citrate preservatives as anticoagulants and other drugs that block neuromuscular transmission: increased neuromuscular blockade.

Analogs

Streptomycin analogs are Streptomycin-calcium chloride complex and Streptomycin-KMP.

Terms and conditions of storage

Store at temperatures up to 25 ° C in the original manufacturer's packaging. Keep out of the reach of children.

Shelf life:

powder for preparation of injection solution - 3 years;
solvent (if available) - 4 years.

Terms of dispensing from pharmacies

Dispensed by prescription.

Reviews of Streptomycin

According to reviews, Streptomycin is highly effective for tuberculosis and other infectious diseases. However, there are often reports of adverse reactions observed during the course of treatment, such as dizziness, disorders of the vestibular apparatus, hearing loss.

Price for Streptomycin in pharmacies

The approximate price for Streptomycin with a dosage of 1000 mg is 397-405 rubles (the package contains 50 bottles).

Anna Kozlova Medical journalist About the author

Education: Rostov State Medical University, specialty "General Medicine".

Information about the drug is generalized, provided for informational purposes only and does not replace the official instructions. Self-medication is hazardous to health!