Streptomycin adverse effects

Impairment of eighth cranial nerve function is the most important adverse effect of streptomycin. Vestibular function is most frequently affected, but hearing may also be impaired. Audiometric testing should be performed in patients who must receive streptomycin for more than 2 months. Streptomycin occasionally causes nephrotoxicity. 

Streptomycin is ototoxic and nephrotoxic. Vertigo and hearing loss are the most common adverse effects and may be permanent. Toxicity is dose-related, and the risk is increased in the elderly. As with all aminoglycosides, the dose must be adjusted according to renal function (see Chapter 45). Toxicity can be reduced by limiting therapy to no more than 6 months whenever possible. 

Some adverse effects of tetracycline. synthesis by the mechanism determined for streptomycin [strep toe... 

Retrobulbar neuritis is the major adverse effect noted in patients treated with ethambutol, Patients usually complain of a change in visual acuity and/or inability to see the color green. Vision testing should be performed on all patients who must receive ethambutol for more than 2 months. Impairment of eighth cranial nerve function is the most important adverse effect of streptomycin, Vestibular function is most frequently affected, but hearing may also be impaired. Audiometric testing should be performed in patients who must receive streptomycin for more than 2 months. Streptomycin occasionally causes nephrotoxicity. 

Serious adverse effects after IPV immunization have not been documented (2). Because IPV contains streptomycin and neomycin, there is a possibility of allergic reactions in those who are sensitive to these antibiotics. Although it has been postulated that IPV, like some viral... 

A Brazilian investigation (49 ) included 112 patients on one of three different antituberculosis regimes in which thiacetazone, at a dose of 150 mg daily, was combined with isoniazid and streptomycin, isoniazid and morfazinamid, or isoniazid and teriz-idone. An unacceptably high incidence (66.3%) of severe adverse effects was reported. The treatment had to be stopped in 13% of patients because of adverse reactions, and 6 of these patients died, 3 of them of exfoliative dermatitis. It is difficult to be sure of the exact role of thiacetazone in these particular adverse effects, but the... 

Two reports from India again stressed the fact that serious dermatological adverse effects are not uncommon with this compound. Bhagi et al. (50 -) reported a case of severe acute epidermal necrolysis developing in a 25-year-old woman treated for 6 weeks with streptomycin and isoniazid followed by 15 days of thiacetazone (150 mg daily) and isoniazid. The patient recovered on withdrawal of the drugs and local and systemic treatment with corticosteroids, and was subsequently treated satisfactorily with a combination of isoniazid and para-aminosalicylic acid. 

An interesting and unusual adverse effect attributed to pyrazinamide was described in a paper from the United States (54 ). A patient was described who suffered several attacks of acute intermittent porphyria whilst under treatment for tuberculosis. The first attack occurred after 18 months therapy with isoniazid and ethambutol. The second episode occurred after 14 days treatment with rifampicin, 7 days treatment with pyrazinamide and 3 days treatment with streptomycin. The patient was subsequently treated successfully with a combination of rifampicin, ethambutol and capreomycin. The compounds were investigated for their capacity to induce hepatic delta-aminolaev-ulinic acid synthesis in an in vitro preparation of rat Uver. The results showed that pyrazinamide had a greater potential for inducing the enzyme activity than any of the other compounds. It is worthy of note, however, that in this in vitro system para-aminosalicylic acid, rifampicin, cycloserine and ethionamide all induced increased delta-aminolaevulinic acid synthesis. 

UNTOWARD EFFECTS In tuberculosis patients treated with streptomycin, 8% had adverse reactions half of which involved the auditory and vestibular functions of the eighth cranial nerve. Other problems included rash and fever. 

The interaction between doxycycline and rifampicin is established and of clinical importance. Monitor the effects of concurrent use and increase the doxycycline dosage as necessary. No clinically important adverse interaction appears to occur between doxycycline and streptomycin. 

An unexpected finding occurred in an in vitro study of the effect of penicillin, streptomycin, neomycin, and Chloromycetin on cellulose digestion in rumen contents. In the concentrations used, penicillin stimulated the cellulolytic rumen microorganisms. At the lower concentrations, neomycin was stimulatory in all concentrations streptomycin was slightly stimulatory in the lowest concentrations and Chloromycetin adversely affected the microorganisms. ... 

---