Aminoglycoside (injectable antituberculosis agent)
Streptomycin is an antibiotic (aminoglycoside) given by intramuscular injection, used mainly to treat tuberculosis and some serious infections, always in combination with other antibiotics. The main risk is toxicity to the ear (hearing and balance) and kidneys.
Also known as: Estreptomicina
Combining Ceftazidime and Streptomycin (an aminoglycoside) increases the risk of nephrotoxicity and ototoxicity.
The ceftazidime label explicitly documents that "nephrotoxicity has been reported following concomitant administration of cephalosporins with aminoglycoside antibacterial drugs or potent diuretics such as furosemide", recommending that "renal function should be carefully monitored, especially if higher dosages of the aminoglycosides are to be administered or if therapy is prolonged, because of the potential nephrotoxicity and ototoxicity of aminoglycosides". The streptomycin label, in turn, classifies the combination with nephrotoxic/neurotoxic drugs (including other aminoglycosides and nephrotoxic cephalosporins) as one to avoid. The combination is used in severe infections (e.g. brucellosis, endocarditis, nosocomial pneumonia) — use with daily creatinine monitoring, dose adjustment to renal clearance and audiovestibular surveillance.
Ceftazidime + streptomycin: nephrotoxicity documented with cephalosporins plus aminoglycosides. Monitor renal function, especially with high doses or prolonged therapy.
Additive nephrotoxic and ototoxic effect of aminoglycosides and cephalosporins, especially in renal impairment or at high doses.
Creatinine/urinalysis, diuresis, hearing (tinnitus, hearing loss), balance.
Rising creatinine, oliguria/renal failure, tinnitus or hearing loss.
Monitor renal function (creatinine) and auditory function; adjust doses for creatinine clearance; avoid prolonged combination.
DailyMed/FDA (NIH/NLM) — approved Ceftazidime label: https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=78982c98-7866-49f1-989f-a289c4242358 ; approved Streptomycin label: https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=abd1f64e-4283-4370-aae8-3666316aa36e — with additional reference: Prontuário Terapêutico do INFARMED, INFARMED (11th ed., 2012)
NSAIDs (Ibuprofen) with aminoglycosides (Streptomycin) raise the risk of renal injury, especially in the elderly or dehydrated.
Streptomycin is an aminoglycoside with well-known nephrotoxicity and ototoxicity; ibuprofen, by inhibiting renal prostaglandins, reduces renal blood flow and can potentiate tubular injury. The combination increases the risk of acute kidney injury, especially in the elderly, in dehydrated patients or in those with pre-existing renal disease. Monitor creatinine during treatment, maintain adequate hydration and use the NSAID only if strictly necessary and at the lowest effective dose.
Streptomycin + ibuprofen: additive risk of nephrotoxicity. Monitor renal function and maintain adequate hydration.
Reduced renal blood flow from NSAIDs and aminoglycoside tubular toxicity.
Renal function (creatinine, urine output).
Oliguria, oedema, rising creatinine.
Avoid NSAIDs during treatment; ensure hydration.
DailyMed/FDA (NIH/NLM) — approved Streptomycin label: https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=abd1f64e-4283-4370-aae8-3666316aa36e ; approved Ibuprofen label: https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=14515409-736f-4119-b6a0-cb19ee2e948e
Additive nephrotoxicity risk between Streptomycin and Diclofenac (an NSAID).
NSAIDs (including diclofenac) inhibit renal prostaglandin synthesis, reducing renal blood flow and glomerular filtration rate — which increases aminoglycoside exposure and nephrotoxicity. The streptomycin label warns that "the concurrent or sequential use of other neurotoxic and/or nephrotoxic drugs... should be avoided" and that "nephrotoxicity does occur, although rarely, streptomycin being the least nephrotoxic of the aminoglycosides". In elderly, hypovolaemic, diabetic or pre-existing renal impairment patients, combining an NSAID with an aminoglycoside can precipitate acute kidney injury. Whenever possible, avoid; if unavoidable (e.g. tuberculosis with inflammatory pain), use the lowest NSAID dose for the shortest time, ensure hydration and monitor creatinine and urine output.
Diclofenac + streptomycin: the NSAID reduces renal perfusion and increases the nephrotoxic risk of the aminoglycoside. Monitor renal function; avoid if possible.
Same NSAID and aminoglycoside mechanism.
Creatinine and urine output.
Acute renal failure (oliguria, fatigue, oedema).
Avoid NSAIDs; hydrate; monitor renal function.
DailyMed/FDA (NIH/NLM) — approved Streptomycin label: https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=abd1f64e-4283-4370-aae8-3666316aa36e ; approved Diclofenac label: https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=b0931350-28a9-4f00-9254-1d72e31f04c3
Combining Streptomycin (an aminoglycoside) with loop diuretics (Furosemide) raises the risk of ototoxicity and nephrotoxicity.
Streptomycin has intrinsic ototoxic potential (predominantly vestibular, with headache, nausea, vomiting and disequilibrium, and high-frequency hearing loss), and furosemide potentiates this potential. The streptomycin label explicitly states that the ototoxic effects of aminoglycosides, including streptomycin, are potentiated by co-administration of furosemide and other diuretics; the furosemide label advises against the combination with aminoglycosides, except in life-threatening situations, especially with impaired renal function. If unavoidable, monitor renal function, audiometry and vestibular signs, and adjust doses.
Streptomycin + furosemide: additive ototoxicity (vestibular and auditory). Avoid the combination, except in life-threatening situations.
Additive toxicity to the inner ear and kidney.
Hearing (tinnitus, hearing loss) and renal function (creatinine).
Tinnitus, hearing loss, dizziness; rising creatinine.
Avoid if possible; if unavoidable, reduce doses and monitor renal function and hearing.
DailyMed/FDA (NIH/NLM) — approved Streptomycin label: https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=abd1f64e-4283-4370-aae8-3666316aa36e ; approved Furosemide label: https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=7cdcd001-ab4b-4210-a455-2e17a7bc4972
No direct interaction is known between streptomycin and alcohol; caution is advised due to the risk of CNS effects.
Limit alcohol intake during treatment.
DailyMed/FDA (NIH/NLM) — approved Streptomycin label: https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=abd1f64e-4283-4370-aae8-3666316aa36e
Streptomycin is given intramuscularly or intravenously; it has no significant food interaction.
No need to adjust dosing around meals.
DailyMed/FDA (NIH/NLM) — approved Streptomycin label: https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=abd1f64e-4283-4370-aae8-3666316aa36e
Streptomycin is ototoxic (cochlear and vestibular); it is contraindicated in patients with prior hearing loss or vestibular disease due to the risk of irreversible deafness.
Contraindicated in prior hearing loss; monitor hearing acuity and balance.
DailyMed/FDA (NIH/NLM) — approved Streptomycin label: https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=abd1f64e-4283-4370-aae8-3666316aa36e
Streptomycin is nephrotoxic and renally excreted; in renal impairment accumulation increases the risk of ototoxicity — adjust the dose.
Adjust the dose to renal function; monitor renal function and signs of ototoxicity.
DailyMed/FDA (NIH/NLM) — approved Streptomycin label: https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=abd1f64e-4283-4370-aae8-3666316aa36e
Streptomycin crosses the placenta and can cause irreversible fetal ototoxicity (8th cranial nerve damage); it is contraindicated in pregnancy.
Contraindicated in pregnancy; choose an alternative antituberculosis regimen.
Excreted into breast milk in small amounts; compatible with breastfeeding under supervision.
No specific additional contraception.
DailyMed/FDA (NIH/NLM) — approved Streptomycin label: https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=abd1f64e-4283-4370-aae8-3666316aa36e
Clinical and educational support tool. The information does not replace a medical prescription or the opinion of a qualified healthcare professional.
Bactericidal aminoglycoside antibiotic that interferes with bacterial protein synthesis, active against mycobacteria (including M. tuberculosis) and several Gram-negatives. After intramuscular injection of 1 g, a peak serum level of 25–50 mcg/mL is reached within 1 hour, declining to ~50% after 5–6 hours.
Streptomycin binds to the bacterial 30S ribosomal subunit, causing mRNA misreading and incorporation of wrong amino acids — protein synthesis is interrupted and the bacterium dies. The action is bactericidal and concentration-dependent.
After intramuscular injection, absorption is rapid and complete, with a peak serum level of 25–50 mcg/mL 1 hour after 1 g. Appreciable concentrations are found in all tissues except the brain; it crosses the placenta (cord blood levels similar to maternal) and small amounts pass into milk.
Streptomycin is excreted by glomerular filtration. In patients with normal kidney function, between 29% and 89% of a single 600 mg dose is excreted in the urine within 24 hours. Any reduction of glomerular function results in decreased excretion and a concurrent rise in serum and tissue levels.
The effective serum half-life is ~5–6 hours (the 25–50 mcg/mL peak declines to about half after 5–6 hours); elimination is prolonged in renal impairment.
Medicines from the same therapeutic group (ATC classification) or the same pharmacological class.
