Streptomycin in tuberculosis

Medical Research Council Streptomycin in Tuberculosis Trials Committee. Streptomycin treatment for pulmonary tuberculosis. Br Med J 1948 ii 769-82. 

Previous reactions to these agents. With the exception of the use of streptomycin in tuberculosis, these agents generally are not indicated in long-term therapy because of the ototoxic and nephrotoxic hazards of extended administration. 

The technique of randomization was pioneered in the field of agriculture (plants too show considerable individual variation) by Sir Ronald Fisher, a visionary statistician. It is generally acknowledged that the first randomized clinical trial, conducted in the 1940s, was a study evaluating the use of streptomycin in treating tuberculosis conducted by the (British) Medical Research Council Streptomycin in Tuberculosis Trials Committee. The results were published in the British Medical Journal in 1948. 

UK from 1840 until near the end of the 20th Century. Horton Hinshaw and William Feldman s paper on Streptomycin in treatment of clinical tuberculosis A preliminary report appeared in the Proceedings of the Mayo Clinic in 1945. For his work on... 

Hinshaw HC, Feldman WH. Streptomycin in treatment of clinical tuberculosis a preliminary report. Proc Mayo Clin 1945 20 313-8. 

Streptomycin is mainly used as a second-line agent for treatment of tuberculosis. The dosage is 0.5-1 g/d (7.5-15 mg/kg/d for children), which is given intramuscularly or intravenously. It should be used only in combination with other agents to prevent emergence of resistance. See Chapter 47 for additional information regarding the use of streptomycin in mycobacterial infections. 

Streptomycin Prevents bacterial protein synthesis by binding to the S12 ribosomal subunit (see also Chapter 45) Bactericidal activity against susceptible mycobacteria Used in tuberculosis when an injectable drug is needed or desirable and in treatment of drug-resistant strains IM, IV renal clearance (half-life 2.5 h) administered daily initially, then 2 x week Toxicity Nephrotoxicity, ototoxicity... 

As a rule, a regimen of two, three, or four of the five first-line antituberculosis drugs (isoniazid, rifampicin, pyrazinamide, ethambutol, and streptomycin) is used in tuberculosis (1). The 6-month short-course regimen consists of isoniazid, rifampicin, and pyrazinamide for 2 months, followed by isoniazid and rifampicin for 4 months (1). It may be advisable to include ethambutol in the initial phase when isoniazid resistance is suspected or if the prevalence of primary resistance to isoniazid is over 4% in new cases. A 9-month regimen consisting of isoniazid and rifampicin is also highly successful (1). Treatment should always include at least two drugs to which the mycobacteria are susceptible. 

Yoshioka, A. Streptomycin, 1946 British Central Administration of Supplies of a New Drug of American Origin with Special Reference to Clinical Trials in Tuberculosis. Ph.D. diss., Imperial College, 1998. 

Streptomycin is used in tuberculosis and is the DOC for bubonic plague and tularemia. 

Streptomycin, an aminoglycoside antibiotic (1 g IM q 12 honrs for two weeks then 500 mg IM q 12 hours for four weeks with penicillin), is indicated in primary and adjnnctive treatment in tuberculosis, for enterococcal endocarditis, and for tularemia. Streptomycin and penicillin prodnce a synergistic bactericidal effect against strains of enterococci, group D streptococci, and the varions oral streptococci of the viridans group. 

Streptomycin is bactericidal for the tubercle bacillus in vitro. The vast majority of strains of M. tuberculosis are sensitive. M. kansasii is frequently sensitive, but other mycobacteria are only occasionally susceptible. Streptomycin in vivo does not eradicate the tubercle bacillus, probably because the drug does not readily enter living cells and thus cannot kill intracellular microbes. 

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. 

Streptomycin is the drug of choice for treatment of plague and tularemia and has important adjunctive value in tuberculosis. Gentamicin (plus tetracycline) is usually preferred in brucellosis, but streptomycin is a backup drug. Aminoglycosides have minimal activity in Lyme disease, which is usually treated with either doxycycUne or amoxicillin. The answer is (C). 

Describe the pharmacodynamic and pharmacokinetic properties of the first-line drugs used in tuberculosis (isoniazid, ethambutol, pyrazinamide, rifampin, and streptomycin). 

It is recommended for use with streptomycin in exudative human tuberculosis. It is used in treating the symptoms of hay fever, urticaria, drug reactions and other mild allergic conditions. Dose 50 mg Usual, adult, oral up to 4 times a day. 

H. Hinshaw and W. H. Feldman, Streptomycin in treatment of clitrical tuberculosis a preliminary report, Mayo Clin. Proc., 20 (1945) 313-318. 

Gopinathan KP, Saroja D (1973) Transduction of isoniazid susceptibility-resistance and streptomycin resistance in mycobacteria. Antimicrob Agents Chemother 4 643-645 Gopinathan KP (1973) Protein synthesis in mycobacterium tuberculosis H 37 Ru and the effect of streptomycin in streptomycin-susceptible and -resistant strains. Antimicrob Agents Chemother 4 205... 

Streptomycin (SM) is an aminoglycoside antibiotic discovered in 1943 and used in tuberculosis treatment since 1948 (Winston, 2012 Schatz, 1993). It is used in injectable form with a dosage of 15 mg/kg body weight (Hmama, 2013) (Figure 11.6). 

Turner JR, Durham TA (2015) Must new drugs be superior to those already available The role of noninfeiiority clinical trials. J CUn Hypertens (Greenwich) 17 319-321 Yoshioka A (1998) Use of randomisation in the Medical Research Council s clinical trial of streptomycin in pulmonary tuberculosis in the 1940s. Br Med J 317 1220-1223... 

From the standpoint of value in treatment, inherited differences in the rate of inactivation of drugs undergoing acetylation were initially considered to be of minimal importance. This has been demonstrated by various studies of patients receiving long-term treatment with isoniazid for pulmonary tuberculosis either in daily doses or in a twice-weekly regimen (Tuberculosis Chemotherapy Centre, 1970 Menon, 1968). With the advent of treatment regimens with longer intervals between successive doses, however, ffie rate of isoniazid inactivation has become of practical importance. One such study involved 117 patients who had been in treatment for 1 year and who had received isoniazid and streptomycin in a... 

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