Streptomycin

For tuberculosis, do not exceed 120 g total over course of treatment; discontinue in case of toxicity or organism resistance

For endocarditis, discontinue in case of ototoxicity

Reduce dosage in case of renal impairment: serum concentration should not exceed 20-25 mcg/mL

Prescribing streptomycin in the absence of a proven or strongly suspected bacterial infection or a prophylactic indication is unlikely to provide benefit to the patient and increases risk of development of drug-resistant bacteria

Care should be taken by individuals handling Streptomycin for Injection to avoid skin sensitivity reactions; as with all intramuscular preparations, Streptomycin for Injection should be injected well within the body of a relatively large muscle and care should be taken to minimize the possibility of damage to peripheral nerves

Exercise extreme caution in selecting a dosage regimen in the presence of preexisting renal insufficiency; in severely uremic patients a single dose may produce high blood levels for several days and the cumulative effect may produce ototoxic sequelae

When streptomycin must be given for prolonged periods of time alkalinization of the urine may minimize or prevent renal irritation

A syndrome of apparent central nervous system depression, characterized by stupor and flaccidity, occasionally coma, and deep respiratory depression, reported in very young infants in whom streptomycin dosage had exceeded the recommended limits; infants should not receive streptomycin in excess of the recommended dosage

In the treatment of venereal infections such as granuloma inguinale, and chancroid, if concomitant syphilis is suspected, suitable laboratory procedures such as a dark field examination should be performed before the start of treatment, and monthly serologic tests should be done for at least four months

As with other antibiotics, use of this drug may result in overgrowth of nonsusceptible organisms, including fungi; if superinfection occurs, appropriate therapy should be instituted

Patients should be counseled that antibacterial drugs including streptomycin should only be used to treat bacterial infections; they do not treat viral infections (eg, the common cold)

When streptomycin is prescribed to treat a bacterial infection, patients should be told that although it is common to feel better early in the course of therapy, the medication should be taken exactly as directed; skipping doses or not completing the full course of therapy may decrease the effectiveness of the immediate treatment and increase the likelihood that bacteria will develop resistance and will not be treatable by streptomycin or other antibacterial drugs in the future