IDENTIFICATION AND USE: streptomycin is an antibiotic produced by the soil actinomycete Streptomyces griseus. It acts by inhibiting the initiation and elongation processes during protein synthesis. Streptomycin is an Aminoglycoside Antibacterial and Antimycobacterial. The chemical classification of streptomycin is Aminoglycosides.

Streptomycin is a broad-spectrum aminoglycoside antibiotic typically used for treatment of active tuberculosis, always in combination with other antituberculosis agents. Streptomycin is usually used in combination with agents that are known to be hepatotoxic and the role of streptomycin in liver injury has been difficult to assess, but most information suggests that streptomycin is not hepatotoxic.

HUMAN EXPOSURE/TOXICITY: intravenous and intramuscular therapy with streptomycin has been linked to mild and asymptomatic elevations in serum alkaline phosphatase, but therapy rarely affects aminotransferase levels or bilirubin and changes typically resolve rapidly once streptomycin is stopped.

Only isolated case reports of acute liver injury with jaundice have been associated with streptomycin therapy and always in combination with other antituberculosis medications which are more clearly hepatotoxic, such as isoniazid, pyrazinamide and rifampin. Streptomycin and the aminoglycosides are not mentioned in large case series of drug induced liver disease and acute liver failure; thus, hepatic injury is exceedingly rare, if it occurs at all.

Nephrotoxic and ototoxic potential. Nephrotoxicity is caused by accumulation of the drug in proximal renal tubular cells, which results in cellular damage. Tubular cells may regenerate despite continued exposure and nephrotoxicity is usually mild and reversible. Streptomycin is the least nephrotoxic of the aminoglycosides owing to the small number of cationic amino groups in its structure. Otoxocity occurs via drug accumulation in the endolymph and perilymph of the inner ear. Accumulation causes irreversible damage to hair cells of the cochlea or summit of the ampullar cristae of the vestibular complex. High frequency hearing loss precedes low frequency hearing loss. Further toxicity may result in retrograde degeneration of the auditory nerve. Vestibular toxicity may result in vertigo, nausea and vomiting, dizziness and loss of balance. LD50=430 mg/kg (Orally in rats with Streptomycin Sulfate); Side effects include nausea, vomiting, and vertigo, paresthesia of face, rash, fever, urticaria, angioneurotic edema, and eosinophilia.

ADVERSE EFFECTS: common side effects include black, tarry stools, burning, crawling, itching, numbness, prickling, “pins and needles”, or tingling feelings, chest pain, chills, clumsiness, cough, dizziness or lightheadedness, feeling of constant movement of self or surroundings, fever, large, hive-like swelling on the face, eyelids, lips, tongue, throat, hands, legs, feet, or sex organs, nausea, painful or difficult urination, sensation of spinning, shortness of breath, sore throat, sores, ulcers, or white spots on the lips or in the mouth, swollen glands, unsteadiness, unusual bleeding or bruising, unusual tiredness or weakness, vomiting.

Less common side effects include back, leg, or stomach pains, bleeding gums, bloody or cloudy urine, blurred vision, change in vision, dark urine, deafness, difficulty with breathing, difficulty with swallowing, dry mouth, fast heartbeat, general body swelling, headache, hives, impaired vision, itching, loss of appetite, muscle weakness, nosebleeds, pain in lower back or side, pale skin, pinpoint red spots on the skin, puffiness or swelling of the eyelids or around the eyes, face, lips, or tongue, skin rash, thirst, tightness in the chest, wheezing, yellowing of the eyes or skin.

Rare side effects include change in the frequency of urination or amount of urine, drowsiness, increased thirst, swelling of the feet or lower legs, and weakness. Severe toxic nerve reactions are possible for patients with kidney problems who use this medication. Kidney function and complete blood counts should be closely monitored by a health care provider while taking this medication. Appropriate medical equipment should be available for patients taking this medication.