Paul A. Pham, Pharm.D. and John G. Bartlett, M.D.
Available formulation in Zambia (Powder for injection): 1 g (as sulfate) vial.
- Addition of streptomycin to EZRH (ethambutol, pyrazinamide, rifampin, and isoniazid) recommended during first 2 months in TB-smear positive re-treatment cases (e.g. treatment failure, treatment after default, smear positive relapse).
- Brucellosis (especially with for osteo-articular or cardiac involvement): streptomycin 1gm IM q24h x 3 weeks PLUS doxycycline 100 mg PO q12h x 6 wks.
- Streptomycin should be avoided in pregnant patients, patients with impaired renal function, and elderly (>65 years old).
Zambia Information Author: Paul A. Pham Pharm.D.
Mycobacterium tuberculosis (2nd line)
Yersinia pestis (plague)
Francisella tularensis (tularemia)
- Brucella infection
Klebsiella granulomatis (Donovanosis, granuloma inguinale),
Haemophilus ducreyi(chancroid);Haemophilus influenzae
- Urinary tract infections(not a first-line agent)
- Endocarditis caused by Streptococcus viridans(used in combination with PCN), Enterococcus faecalis (use with ampicillin)
- Gram-negative bacillary bacteremia (concomitantly with another antibacterial agent) 11) K. pneumoniae pneumonia
*Prices represent cost per unit specified and are representative of "Average Wholesale Price" (AWP).
AWP Prices were obtained and gathered by Lakshmi Vasist Pharm D using the Red Book, manufacturer's
information, and the McKesson database.
^Dosage is indicated in mg unless otherwise noted.
- TB: 15mg/kg/d (max 1gm) IM once daily.
- TB DOT regimen:25-30mg/kg IM 2-3x/wk.
- Enterococcal endocarditis (synergy with ampicillin if resistant to gentamicin and sensitive to streptomycin): 7.5mg/kg IM q12h (max dose per day is 2gm with a target peak 1hour after IM dose of 20mcg/ml and trough <10 mcg/mL).
TB: 15 mg/kg q24-72h (monitor serum concentrations; target trough <10 mcg/mL); Synergy for enterococcal endocarditis: 7.5 mg/kg q12-24h (monitor serum concentrations; target trough <10 mcg/mL).
TB: 15mg/kg q72-96h (monitor serum concentrations; target trough <10 mcg/mL). Synergy for enterococcal endocarditis: 7.5 mg/kg q24-72h (monitor serum concentrations; target trough <10 mcg/mL).
TB and synergy for Enterococcal endocarditis: 7.5mg/kg q72-96h (monitor serum concentrations; target trough <10 mcg/mL).
TB: 12-15mg/kg 2-3x/week (monitor serum concentrations; target trough <10 mcg/mL). Synergy for enterococcal endocarditis: 7.5 mg/kg q96h (monitor serum concentrations; target trough <10 mcg/mL).
20-40mg/Liter of dialysate per day (monitor serum concentrations closely; target trough <10 mcg/mL).
15 mg/kg q24 to 72h (dose adjust based on serum concentrations; target trough <10 mcg/mL).
- Renal failure
- Otological/vestibular damage. The most ototoxic of all aminoglycosides. Peak should not exceed 20-25 mcg/mL.
- Optic nerve dysfunction
- Peripheral neuritis
- Neuromuscular blockade
- Loop diuretic (especially w/ ethacrynic acid): additive ototoxicity. Avoid co-administration with streptomycin.
- Nephrotoxic agents (e.g., cidofovir, foscarnet, pentamidine, ampho B): may increase risk of nephrotoxicity. Avoid co-administration with streptomycin.
- Non-depolarizing muscle relaxants (e.g., atracurium, pancuronium, tubocurarine, gallamine triethiodide): may increase risk of neuromuscular blockade with large doses. Use with close monitoring.
Enterococci synergy with ampicillin if MIC <1000 mcg/mL.
Parenteral aminoglycoside with the most ototoxicity potential. Use is generally limited to treatment of multiple-drug resistant tuberculosis (MDRTB), but high rates of streptomycin resistance has been described in high-incidence countries. Also used for unusual infections: plague, tularemia and brucellosis. May be synergistic with ampicillin in cases of gentamicin resistant enterococcusendocarditis.