Yes

Antibiotic, Aminoglycoside; Antitubercular Agent

Part of combination therapy of active tuberculosis; used in combination with other agents for treatment of streptococcal or enterococcal endocarditis, mycobacterial infections, plague, tularemia, and brucellosis

D

Hypersensitivity to streptomycin or any component

Use with caution in patients with pre-existing vertigo, tinnitus, hearing loss, neuromuscular disorders, or renal impairment; modify dosage in patients with renal impairment; aminoglycosides are associated with significant nephrotoxicity or ototoxicity; the ototoxicity is directly proportional to the amount of drug given and the duration of treatment; tinnitus or vertigo are indications of vestibular injury and impending bilateral irreversible damage; renal damage is usually reversible

1% to 10%:

Central nervous system: Neurotoxicity

Renal: Nephrotoxicity

Otic: Ototoxicity (auditory), ototoxicity (vestibular)

<1%: Skin rash, drug fever, headache, paresthesia, tremor, nausea, vomiting, eosinophilia, arthralgia, anemia, hypotension, difficulty in breathing, drowsiness, weakness

Symptoms of overdose include ototoxicity, nephrotoxicity, and neuromuscular toxicity

The treatment of choice following a single acute overdose appears to be the maintenance of good urine output of at least 3 mL/kg/hour. Dialysis is of questionable value in the enhancement of aminoglycoside elimination. If required, hemodialysis is preferred over peritoneal dialysis in patients with normal renal function. Careful hydration may be all that is required to promote diuresis and therefore the enhancement of the drug's elimination.

Increased/prolonged effect: Depolarizing and nondepolarizing neuromuscular blocking agents

Increased toxicity: Concurrent use of amphotericin may increase nephrotoxicity

Depending upon manufacturer, reconstituted solution remains stable for 2-4 weeks when refrigerated; exposure to light causes darkening of solution without apparent loss of potency

Inhibits bacterial protein synthesis by binding directly to the 30S ribosomal subunits causing faulty peptide sequence to form in the protein chain

Absorption: I.M.: Absorbed well

Distribution: To extracellular fluid including serum, abscesses, ascitic, pericardial, pleural, synovial, lymphatic, and peritoneal fluids; crosses the placenta; small amounts appear in breast milk

Half-life: Newborns: 4-10 hours; Adults: 2-4.7 hours and is prolonged with renal impairment

Elimination: Almost completely (90%) excreted as unchanged drug in urine, with small amounts (1%) excreted in bile, saliva, sweat, and tears

Children:

Daily therapy: 20-30 mg/kg/day (maximum: 1 g/day)

Directly observed therapy (DOT): Twice weekly: 25-30 mg/kg (maximum: 1.5 g)

DOT: 3 times/week: 25-30 mg/kg (maximum: 1 g)

Adults:

Daily therapy: 15 mg/kg/day (maximum: 1 g)

Directly observed therapy (DOT): Twice weekly: 25-30 mg/kg (maximum: 1.5 g)

DOT: 3 times/week: 25-30 mg/kg (maximum: 1 g)

Enterococcal endocarditis: 1 g every 12 hours for 2 weeks, 500 mg every 12 hours for 4 weeks in combination with penicillin

Streptococcal endocarditis: 1 g every 12 hours for 1 week, 500 mg every 12 hours for 1 week

Tularemia: 1-2 g/day in divided doses for 7-10 days or until patient is afebrile for 5-7 days

Plague: 2-4 g/day in divided doses until the patient is afebrile for at least 3 days

Elderly: 10 mg/kg/day, not to exceed 750 mg/day; dosing interval should be adjusted for renal function; some authors suggest not to give more than 5 days/week or give as 20-25 mg/kg/dose twice weekly

Dosing interval in renal impairment:

Cl_cr 10-50 mL/minute: Administer every 24-72 hours

Cl_cr <10 mL/minute: Administer every 72-96 hours

Removed by hemo and peritoneal dialysis: Administer dose postdialysis

Hearing (audiogram), BUN, creatinine; serum concentration of the drug should be monitored in all patients; eighth cranial nerve damage is usually preceded by high-pitched tinnitus, roaring noises, sense of fullness in ears, or impaired hearing and may persist for weeks after drug is discontinued

Therapeutic: Peak: 20-30 mg/mL; Trough: <5 mg/mL; Toxic: Peak: >50 mg/mL; Trough: >10 mg/mL

False-positive urine glucose with Benedict's solution or Clinitest®; penicillin may decrease aminoglycoside serum concentrations in vitro

May cause drowsiness

None reported

No information available to require special precautions

No effects or complications reported

This medication can only be given by intramuscular injection. Therapy for TB or HIV will generally last several months. Do not discontinue even if you are feeling better. Maintain adequate hydration (2-3 L/day of fluids unless instructed to restrict fluid intake). You may experience headache or dizziness (use caution when driving or engaging in tasks requiring alertness until response to drug is known); nausea, vomiting, or loss of appetite (frequent small meals, frequent mouth care, sucking lozenges, or chewing gum may help). Report immediately any rash, joint or back pain, or difficulty breathing; swelling of extremities or weight gain greater than 5 lb/week; fever, chills, mouth sores, vaginal itching or drainage, or foul-smelling stool; change in hearing, ringing or sense of fullness in ears; numbness, loss of sensation, clumsiness, change in strength, or altered gait. Pregnancy precautions: Do not get pregnant while taking this medication; use appropriate barrier contraceptive measures.

Injection, as sulfate: 400 mg/mL (2.5 mL)

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