Streptomycin

Streptomycin is an antibiotic from the aminoglycoside class that is often used to treat various bacterial infections. Here is some information about it:

1. Mechanism of Action: Streptomycin acts by binding to bacterial ribosomes and interfering with the process of protein synthesis, resulting in the death of the bacteria.
2. Use: Streptomycin is widely used to treat infections caused by Gram-negative bacteria such as Escherichia coli and Klebsiella pneumoniae. It can be used to treat urinary tract infections, respiratory infections, skin infections, sepsis and others.
3. Dosage forms: Streptomycin is available in a variety of forms, including injectable powder for preparing a solution, and ointments and drops for the treatment of topical infections.
4. Contraindications: Streptomycin is not recommended for people with known allergies to aminoglycosides or other components of the drug, or for those with kidney function or hearing problems.
5. Side effects: Side effects from streptomycin may include nausea, vomiting, diarrhea, hearing changes (including tinnitus), increased blood creatinine levels, and others.
6. Notes: Streptomycin is usually used in hospitalized patients and under the supervision of a physician because of its potentially serious side effects. Prolonged use may also cause bacteria to develop resistance to the drug.

Indications Streptomycin

1. Urinary tract infections: Streptomycin may be used to treat urinary tract infections such as cystitis (inflammation of the bladder) and pyelonephritis (inflammation of the kidney calyces and pelvis).
2. Respiratory infections: The drug may be used to treat respiratory infections such as pneumonia (inflammation of the lungs) and bronchitis (inflammation of the bronchi).
3. Skin and soft tissue infections: Streptomycin can be used to treat a variety of skin and soft tissue infections, including acute and chronic wounds, burns, boils, and abscesses.
4. Sepsis: Insepsis, a systemic infection where bacteria enter the bloodstream, streptomycin may be used in combination with other antibiotics to reduce the bacterial load and prevent complications.
5. Prophylaxis before surgery: Streptomycin is sometimes used as a prophylactic antibiotic before surgery to prevent infections after surgery.
6. Tuberculosis: In rare cases, streptomycin may be used as a component of combination therapy for the treatment of tuberculosis.

Release form

1. Powder for preparation of solution for injection

• Description: Streptomycin is usually supplied as a sterile powder that is dissolved before use for intramuscular injection.
• Available dosages: 1 gram vials are most common, although other dosages may be available.
• Preparation method: Powder is dissolved in water for injection or other suitable solvent as indicated in the instructions for medical use.

2. Prepared solutions for injection

• Description: Streptomycin may sometimes be available as a ready-to-use solution for injection, which makes it easier to use because no pre-preparation is required.
• Available dosages: Like the powder, the finished solution usually contains a certain amount of active ingredient in milligrams per milliliter.

Pharmacodynamics

Streptomycin is an antibiotic that is used to combat various bacterial infections. Its pharmacodynamics is related to its ability to inhibit bacterial growth and reproduction. It acts by binding to bacterial ribosomes and interfering with protein synthesis, resulting in the death of the bacteria.

Streptomycin has activity against a variety of Gram-positive and Gram-negative bacteria. These may include such species as:

1. Gram-positive bacteria:

   • Streptococci (e.g. Streptococcus pneumoniae, Streptococcus pyogenes)
   • Staphylococcus aureus (e.g., Staphylococcus aureus, including methicillin-resistant strains)
   • Listeria (Listeria monocytogenes)
   • Clostridia (e.g. Clostridium perfringens)

2. Gram-negative bacteria:

   • Escherichia (Escherichia coli)
   • Salmonella spp.
   • Protea (Proteus spp.)
   • Shigella spp.
   • Klebsiella (Klebsiella pneumoniae)
   • Pseudomonads (Pseudomonas aeruginosa) - sometimes has a moderate effect, but is usually more resistant to streptomycin.

However, due to the possible development of resistance and potential side effects, it should be used with caution and only when prescribed by a physician.

Pharmacokinetics

1. Absorption: Streptomycin is generally not absorbed from the gastrointestinal tract after oral administration and is usually administered intravenously or intramuscularly.
2. Distribution: After administration by intravenous or intramuscular injection, streptomycin is rapidly distributed in tissues and body fluids, including blood, lungs, kidneys, and heart muscle.
3. Metabolism: Streptomycin is not normally metabolized in the body.
4. Excretion: Most streptomycin is excreted through the kidneys by glomerular filtration.
5. Half-life: The half-life of streptomycin from the body is about 2-3 hours in adults, but may be prolonged in patients with impaired renal function.

Dosing and administration

Method of application

Streptomycin is usually administered intramuscularly (IM), less often intravenously (IV) as an infusion. The drug is not intended for oral administration as it is not absorbed through the gastrointestinal tract.

• Preparation of solution: For intramuscular injection streptomycin powder is dissolved in sterile water for injection. Usually 2-5 ml of solvent is used per 1 g of powder. The solution should be administered immediately after preparation to avoid loss of activity.
• Method of administration: Intramuscular injections should be given deep into a large muscle (e.g. Gluteal muscle) to minimize tissue irritation and reduce the pain of the injection.

Dosage

Adults

• Tuberculosis: The standard dose is 15 mg/kg body weight once daily, not exceeding 1 g per day. The course of treatment usually lasts 6-9 months in combination with other anti-TB drugs.
• Brucellosis: 1 g twice daily for 1-2 weeks in combination with doxycycline.
• Plague, tularemia and other gram-negative infections: 1-2 g per day, divided into two injections.

Children

• Tuberculosis and other infections: The dosage is 20-40 mg/kg body weight per day divided into 1-2 injections, without exceeding the maximum daily dose of 1 g.

Use Streptomycin during pregnancy

Streptomycin is generally not recommended for use during pregnancy, especially in the first trimester, unless the benefits outweigh the potential risks to the fetus. This antibiotic can penetrate the placenta and have toxic effects on the developing fetus. However, in certain situations where other antibiotics cannot be used or are less effective, your doctor may prescribe streptomycin.

Contraindications

1. Hypersensitivity or allergic reaction: People with known hypersensitivity to streptomycin or other aminoglycoside class antibiotics should avoid its use because of the possibility of allergic reactions.
2. Inner ear damage(labyrinthitis): Streptomycin may cause damage to the auditory nerve and sensory hearing loss, therefore its use may be contraindicated in labyrinthitis or other inner ear diseases.
3. Pregnancy and breastfeeding: The use of streptomycin during pregnancy may affect the development of the fetus, therefore its administration should be done with caution and under medical supervision. The benefits and risks of streptomycin use during breastfeeding should also be discussed.
4. Renalinsufficiency: In renal impairment, an increase in blood concentrations of streptomycin may be observed, which may lead to increased toxicity. Therefore, dose adjustment may be required in patients with renal impairment.
5. Myasthenia gravis: In patients with myasthenia gravis, the use of streptomycin may exacerbate muscle weakness due to its neuromuscular blocking action.

Side effects Streptomycin

1. Kidney and hearing toxicity: This is one of the most serious side effects of streptomycin. Prolonged use or use in high doses can cause kidney damage and hearing impairment. Close monitoring of kidney function and hearing is necessary with long-term antibiotic treatment.
2. Nervous System Toxicity: In rare cases, neurotoxic effects such as dizziness, headache, increased drowsiness, insomnia and other symptoms of nervous agitation or depression may occur.
3. Allergic reactions: Some people may develop allergic reactions to streptomycin, manifested as skin rash, itching, hives, or even anaphylactic shock in severe cases.
4. Dyspeptic Disorders: Diarrhea, nausea, vomiting or other gastrointestinal disorders may occur.
5. Superinfections: Prolonged use of streptomycin or its broad spectrum of action may contribute to the development of superinfections caused by the growth of antibiotic-resistant microorganisms.
6. Other side effects: Other rare side effects may occur, including increased blood bilirubin levels, allergic vasculitis, increased liver enzymes, and others.

Overdose

Streptomycin overdose can lead to serious side effects including neuromuscular disorders, poisoning, kidney and hearing dysfunction. Symptoms of overdose may include vomiting, diarrhea, headaches, impaired consciousness, and hypersensitivity to light and sound. If a streptomycin overdose is suspected, medical attention should be sought immediately. Treatment of overdose usually includes symptomatic therapy and maintenance of vital body functions.

Interactions with other drugs

1. Aminoglycosides: Concomitant use of streptomycin with other aminoglycosides such as gentamicin or amikacin may increase the risk of renal and hearing toxicity.
2. Other antibiotics: The use of streptomycin with other antibiotics, especially synergistic antibiotics, may enhance its antimicrobial action. However, combination with other antibiotics may also increase the risk of side effects.
3. Drugs affectingrenal function: Drugs that affect renal function, such as certain nonsteroidal anti-inflammatory drugs (NSAIDs), diuretics, or angiotensin-converting enzyme (ACE) inhibitors, may increase the risk of renal toxicity when used concomitantly with streptomycin.
4. Neuromuscular blockers: Use of streptomycin with neuromuscular blockers such as pancuronium or vecuronium may increase their toxicity and prolong their effects.
5. Drugs affecting the cardiovascular system: The combination of streptomycin with drugs affecting the cardiovascular system, such as digoxin or antiarrhythmic drugs, may increase the risk of cardiotoxicity.