Streptomycin nephrotoxicity

Streptomycin Adults See footnote8 Children 20-40 mg/kg per day Ototoxicity, neurotoxicity, nephrotoxicity Baseline audiogram, vestibular testing, Romber testing and SCr Monthly assessments of renal function and auditory or vestibular symptoms... 

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 must be given i.v. (pp. 278ff) like other aminoglycoside antibiotics. It damages the inner ear and the labyrinth. Its nephrotoxicity is comparatively minor. 

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. 

Renal toxicity - Renal toxicity may be characterized by decreased creatinine clearance, cells or casts in the urine, decreased urine specific gravity, oliguria, proteinuria, or evidence of nitrogen retention. Renal damage is usually reversible. The relative nephrotoxicity of these agents is estimated to be Kanamycin = Amikacin = Gentamicin = Tobramycin Streptomycin. 

Avoid concurrent or sequential use of other neurotoxic and/or nephrotoxic drugs with streptomycin sulfate, including neomycin, kanamycin, gentamicin, cephaloridine, paromomycin, viomycin, polymyxin B, colistin, tobramycin, and cyclosporine. 

Ototoxicity and nephrotoxicity are the major concerns during administration of streptomycin and other aminoglycosides. The toxic effects are dose related and increase with age and underlying renal insufficiency. All aminoglycosides require dose adjustment in renal failure patients. Ototoxicity is severe when aminoglycosides are combined with other potentially ototoxic agents. 

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. 

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... 

They are active against many gram-negative bacteria but resistance develops rapidly and limits their use. Streptomycin and dihydrostreptomycin are less nephrotoxic than other aminoglycosides. They may cause neurological distur-... 

This dose is used in patients over 40 years of age if they have subclinical renal failure. Streptomycin is an aminoglycoside so is associated with oto- and nephrotoxicity. Monitoring is by blood levels with peak 1 hour post dose below 40 mg/L and trough below 3 mg/L. 

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. 

The same spectrum of toxicity (ototoxicity and nephrotoxicity) is shared by all members of the group, The more important and frequent interactions are pharmacodynamic. Streptomycin and gentamicin produce predominantly vestibular effects, whereas amikacin, kanamycin and neomycin primarily affect auditory function. All are rapidly excreted by the kidney,... 

Capreomycin should never be combined with streptomycin or other aminoglycosides because of nephrotoxicity and ototoxicity (3). 

Since the discovery of streptomycin in 1944, aminoglycosides have endured as indispensable agents in the antimicrobial armamentarium. This is despite their well described potential for serious nephrotoxicity and otoxicity and the emergence of other classes of antibiotics with similar antibacterial spectrums. The major aminoglycoside antibiotics in... 

Streptomycin 7.5 mg/kgq. 12hr (1.0 gq. 24 hr forTB) 60% q. 24hr q. 24-72 hr q.72-96 hr May be less nephrotoxic than other members of class Half normal dose after dialysis 20-40 mg/L/ day Dose for GFR 10-50 ml/min measure leyels... 

Clinically, a problem that sometimes (Kcurs with the use of streptomycin is the early development of resistant. strains of bacteria, necessitating a change in therapy. Other factors that limit the therapeutic use of streptomycin arc chronic toxicities. Neurotoxic reactions have been observed after the use of streptomycin. These are characterized by vertigo, disturbance of equilibrium, and diminished auditory perception. Additionally, nephrotoxicity (K curs with some frequency. 

Streptomycin occasionally causes nephrotoxicity, although it tends to be mild and reversible. It also is capable of causing ototoxicity (vestibular and cochlear), which may become permanent with continued use. Older patients and those receiving long durations of treatment are most likely to experience hearing loss, whereas vestibular toxicity is highly unpredictable. 

Streptomycin Protein synthesis inhibition Deafness, vestibular dysfunction, nephrotoxicity... 

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