Introduction - Uppsala Monitoring Centre

clearance ↓, Blood urea nitrogen ↑)
5. Neurotoxicity. Almost all patients on prolonged courses will
develop vestibular damage. 96% at 2 gm daily for 120 days. Daily
dose of 1 gm daily reduces incidence by 20%.
6. Deafness is not common, but is dose related and partly reversible.
7. Blood dyscrasias: eight cases reported: five mild leukopenia with
neutropenia, three cases of agranulocytosis. Thrombocytopenia
was rare (Farber and Eagle, 1948).
1948 August Canada. The drug became available on May 2nd 1947, but in such
limited supplies that only the most serious cases could be treated.
The dosage started at 3 gm daily but by November had been
reduced to 1 gm daily. Case series of 100 patients: there were 6
deaths and 32 patients suffered ADRs: minor skin lesions, slight
dizziness, nausea and occasional vomiting. One patient had severe
dizziness, which reversed on dechallenge, and three others had
severe nausea, vomiting and dizziness; two of whom died and the
other recovered from the toxic effect. One patient after local
application developed an itchy erythematous rash with positive
rechallenge. Original dose 3 gm daily then reduced to 2 gm daily and
finally 1 gm daily.
Comment: no precise numbers of patients suffering individual
events. No mention of any dose-relationship (Kincade et al., 1948).
No controlled trials had been undertaken in the US.
1948 October MRC Streptomycin in Tuberculosis Trials Committee. Streptomycin
treatment of pulmonary tuberculosis. Randomised control trial. Total
number of patients 107; 52 on bed rest only and 55 on bed rest plus
streptomycin at a dose of 2 gm daily. The duration of the study was 6
months.
‘Toxic effects’ were observed in many patients and ‘the effects will
only be described briefly because they have already been described
by other investigators.’
1. Giddiness was noticed by 36 out of 55 patients with nystagmus
coming on after 6 weeks in some patients.
2. Two cases of high-tone deafness
3. Many patients suffered from nausea and vomiting.
4. Albuminuria and casts in urine and raised blood urea
5. Pruritus, urticarial rash and eosinophilia
6. Yellow vision after injection
7. Circumoral numbness (Streptomycin in Tuberculosis Trials
Committee, 1948).