BLACK BOX WARNING
- ototoxicity (predominantly vestibular)
- nephrotoxicity
- neuromuscular blockade
streptomycin
Brand: Streptomycin Sulfate
⚠ BBW TDM Required Prototype: gentamicin
Drug Class: aminoglycoside antibiotic
Drug Family: antibiotic
Subclass: first aminoglycoside; anti-tuberculosis agent
Organ Systems: infectious-disease
Mechanism of Action
Binds irreversibly to the 30S ribosomal subunit, causing misreading of mRNA; particularly active against Mycobacterium tuberculosis and some gram-negative organisms; the first aminoglycoside and first antibiotic effective against tuberculosis.
30S ribosomal subunit
Indications
- tuberculosis (as part of combination therapy — second-line)
- enterococcal endocarditis (in combination with penicillin)
- brucellosis
- tularemia
- plague (Yersinia pestis)
Contraindications
- aminoglycoside hypersensitivity
- pregnancy (high ototoxicity risk)
Adverse Effects
Common
- vestibular toxicity (dizziness, nystagmus, ataxia)
- nephrotoxicity
- injection site pain
Serious
- irreversible vestibular toxicity
- irreversible hearing loss (less common than vestibular toxicity)
- neuromuscular blockade
- fetal ototoxicity
Pharmacokinetics (ADME)
| Absorption | IM only (not absorbed orally) |
| Distribution | extracellular distribution; poor CNS penetration |
| Metabolism | not metabolized |
| Excretion | renal (unchanged) |
| Half-life | 2.5 hours (normal renal function) |
| Onset | 30–90 minutes (IM) |
| Peak | 1–2 hours |
| Duration | 24 hours |
| Protein Binding | 35% |
| Vd | low |
Drug Interactions
| Drug / Agent | Mechanism | Severity |
|---|---|---|
| loop diuretics | additive ototoxicity | major |
| other nephrotoxins | additive nephrotoxicity | major |
Nursing Considerations
- Administer IM only; no IV formulation is commercially available in most countries.
- Monitor vestibular function (balance, gait, dizziness) regularly — vestibular toxicity from streptomycin is more common than cochlear toxicity.
- Monitor BUN and SCr; reduce dose or extend interval in renal impairment.
- In tuberculosis regimens, streptomycin is given as part of standardized combinations; counsel patients on the importance of adherence to prevent resistance.
Clinical Pearls
- Streptomycin has a distinctive toxicity profile: vestibular toxicity (causing dizziness, vertigo, and nystagmus) is more common than the cochlear ototoxicity seen with gentamicin and tobramycin.
- For enterococcal endocarditis, synergy between streptomycin (or gentamicin) and a cell-wall agent (penicillin or ampicillin) is essential; aminoglycoside high-level resistance (MIC >2000 mcg/mL) eliminates this synergy.
Safety Profile
Pregnancy use-with-caution
Lactation use-with-caution
Renal Adjustment Required
Hepatic Adjustment Not required
TDM Required
Concordance Terms
Cross-referenced clinical concepts — click any term to see all content where it appears.