Interventions for Tuberculosis Control and Elimination 2002

ney function is impaired, the dosage must be adjusted, as excretion is exclusively
renal. 56 Streptomycin has a limited ability to penetrate membranes,
resulting in low concentrations of cerebrospinal fluid. 402
Dosage. After large doses (up to three grams daily were given in the early
trials 395 ) toxicity was frequent and dosage reductions were sought that would
not compromise efficacy. 403 The current recommendation is to give
15 mg/kg body weight (range 12 to 18), 8, 13 with a usual maximal dose of
one gram in adults. The dosage is reduced in elderly patients. It has to
be administered parenterally, usually by intramuscular injection, but intravenous
application is preferred by some because of higher peak but lower
trough levels. 404
Adverse drug events (table 6). The main adverse effect of streptomycin is
vestibulo-cochlear toxicity, which is usually 323,403,405 but not always, dosedependent.
406 Hypersensitivity reactions are also relatively frequent and
important, 56 not only in patients, but also in health care personnel administering
the medication. 407 Because of its penetration into amniotic fluid
and its ototoxic effect on the fetus, 408 streptomycin should never be administered
to pregnant women. 56 Streptomycin may cause neuromuscular blockade,
409 not reversed by neostigmine. 410
Table 6. Summary of adverse reactions from streptomycin with estimated frequencies
of occurrence. Note that these are estimates of frequencies, which may
vary across population groups.
Frequent Common Infrequent Rare
(� 5 per 100) (� 1 per 100 and (� 1 per 1,000 (< 1 per 1,000)
< 5 per 100) and < 1 per 100)
Vestibular Cochlear toxicity Renal damage Neuromuscular
toxicity Hypersensitivity blockade
reactions
Interactions
Effect of streptomycin potentiated: Ototoxicity of streptomycin is increased
by diuretics such as furosemide 411 and ethacrynic acid. 412
Effect of streptomycin opposed: None identified.
Effect of drug potentiated by streptomycin: Like other aminoglycosides,
streptomycin has a neuromuscular blocking effect 413 and may lead to pro-
44