Streptomycin sulfate
Producer: JSC Himfarm Republic of Kazakhstan
Code of automatic telephone exchange: J01JA01
Release form: Liquid dosage forms. Powder for preparation of solution for injections.
General characteristics. Structure:
Active agent - streptomycin sulfate (in terms of streptomycin) 1,0.
Pharmacological properties:
Pharmacokinetics. It is badly soaked up from digestive tract and it is almost completely removed through intestines, applied only parenterally. Streptomycin at intramuscular introduction is quickly and completely absorbed in blood. Its maximum concentration in blood is observed in 1–2 hours. After single introduction in an average therapeutic dose the antibiotic is defined in blood within 6–8 hours. High concentration of drug in lungs, kidneys, a liver, extracellular liquid are created. Does not get through the unimpaired blood-brain barrier. Well gets into a placenta and into breast milk. Drug contacts proteins of a blood plasma less than 10%. At normal secretory function of kidneys at repeated introductions does not collect in an organism. It is not metabolized. The elimination half-life makes 2–4 hours. It is excreted generally by kidneys (95%) in not changed look. Removal of drug is slowed down at an impaired renal function, at the same time its concentration in an organism increases and side reactions can develop (neurotoxic).
Pharmacodynamics. Antibiotic of group of aminoglycosides of a broad spectrum of activity.
It is active concerning Mycobacterium tuberculosis, the majority of gram-negative: Escherichia coli, Salmonella spp., Shigella spp., Yersinia spp., Klebsiella spp. (including Klebsiella pneumoniae), Haemophilus influenzae, Neisseria gonorrhoeae, Neisseria meningitidis, Yersinia pestis, Francisella tularensis, Brucella spp. and some gram-positive microorganisms: Staphylococcus spp., Corynebacterium diphtheriae. Is less active concerning Streptococcus spp. (including Streptococcus pneumoniae), Enterobacter spp. Streptomycin is not active concerning anaerobic bacteria, Spirochaetaceae, Rickettsia spp., Proteus spp., Pseudomonas aeroginosa.
Has bactericidal effect as a result of linkng with 30S-subunit of a bacterial ribosome that leads further to oppression of synthesis of protein.
Indications to use:
- primary pulmonary tuberculosis and other bodies (including tubercular meningitis)
- the pneumonia caused by klebsiyella
- plague (in a combination with tetracycline)
- a tularemia (in a combination with tetracycline)
- a brucellosis (in combination with other antibiotics)
- an endocarditis (in combination with other antibiotics)
Route of administration and doses:
Intramuscular introduction (in oil).
Single dose for adults at introduction in oil – 0,5-1 g, daily - 1-2 g. At bad portability the patient with body weight less than 50 kg and to persons are more senior than 60 years - in a daily dose of 750 mg.
For children (in oil):
- aged up to 3 months - in a dose at the rate of 10 mg/kg/days
- aged from 3 up to 6 months - 15 mg/kg
- from 6 months to 2 years - 20 mg/kg
- up to 13 years and teenagers a daily dose - 15-20 mg/kg, but no more than 500 mg/days - for children up to 13 years and 1 g/days - for teenagers.
Maximum doses:
- to children under 2 years - 20 mg/kg/days;
- 3-4 years - one-time - 150 mg, daily - 300 mg
- 5-6 years - one-time - 175 mg, daily - 350 mg
- 7-9 years - one-time - 200 mg, daily - 400 mg
- 9-14 years - one-time - 250 mg, daily - 500 mg.
At not tubercular etiology introduction frequency - 3-4 times a day, treatment duration - 7-10 days. At treatment of tuberculosis the daily dose is entered into 1 reception, at bad portability - into 2 receptions, treatment duration - 3 months and more.
Features of use:
At prolonged use of streptomycin the nephrotoxicity phenomena (a proteinuria, a hamaturia, a cylindruria) therefore during treatment it is necessary at least 1 time a month can be observed to investigate urine.
During treatment by streptomycin it is necessary to control functions of vestibular and acoustical devices, functions of kidneys.
The patient with disturbances of secretory function of kidneys, and also to patients with damages of a liver it is necessary to reduce a daily dose.
At unsatisfactory audiometric tests the dose of drug is reduced or stop treatment.
In the absence of positive clinical dynamics it is necessary to remember a possibility of development of resistant microorganisms. In similar cases it is necessary to cancel treatment and to begin performing the corresponding therapy.
To babies drug is appointed only according to vital indications.
Considering side effects of drug, it is necessary to be careful at management of transport or potentially dangerous mechanisms.
Side effects:
Often:
- headache, drowsiness, weakness
- abnormal liver function (increase in activity of "hepatic" transaminases, hyperbilirubinemia, increase in ALT)
- blockade of the VIII pair of cranial nerves and vestibular frustration (instability of gait) connected with it
- hearing disorder (noise, ring, decrease in hearing, deafness)
- peripheral neuritis
- neuritis of a facial nerve (a burning sensation in a face or an oral cavity, numbness, a pricking)
- nephrotoxicity (significant increase or reduction of frequency of an urination, oliguria, polyuria, thirst, anorexia).
Seldom:
- neuromuscular blockade at simultaneous introduction with muscle relaxants (breath difficulty, a night apnoea, an apnoea)
- neurotoxic action (twitching of muscles, paresthesias, epileptic seizures)
- albuminuria, hamaturia
- convulsive reductions of muscles
- polyneuropathy
- allergic reactions (itch, skin rash, dermahemia, small tortoiseshell, fever, eosinophilia, Quincke's edema, Quincke's disease, fever, etc., acute anaphylaxis)
- lowering of arterial pressure
- reddening and pain in an injection site
- pains of the squeezing character in heart, tachycardia
Interaction with other medicines:
Mixing of streptomycin in one syringe with antibiotics of a penicillinic row (карбенициллин, etc.) and cephalosporins is inadmissible.
At simultaneous use with aminoglycosides, polymyxins, kapreomitsiny, furosemide, kurarepodobny drugs the risk of development from - and nephrotoxic action increases. Reduces efficiency of anti-myasthenic drugs.
Shows a synergism at co-administration with a beta laktamnymi antibiotics.
Removal of streptomycin from an organism slows down parenteral administration of indometacin. Streptomycin strengthens side effects from - and nefrotoksichny means, muscle relaxants, a metoksifluran, reduces efficiency of anti-myasthenic means, it is not appointed with diuretics and against the background of dehydrational therapy. Drugs for an inhalation anesthesia (galogensoderzhashchy hydrocarbons), opioid analgetics, transfusion big amount of blood with citrate preservatives as anticoagulants, other medicines blocking neuromuscular transmission strengthen neuromuscular blockade.
Contraindications:
- hypersensitivity to streptomycin (including to other aminoglycosides in the anamnesis)
- the diseases of acoustical and vestibular devices connected with neuritis of the VIII pair of cranial nerves and after the postponed otonevrit
- severe forms of cardiovascular insufficiency
- a chronic renal failure with an azotemia and uraemia
- disturbances of cerebral circulation
- botulism
- tendency to bleedings
- epilepsy
- pregnancy and period of a lactation
Overdose:
Symptoms: toxic reactions (a hearing loss, an ataxy, dizziness, frustration of an urination, thirst, anorexia, nausea, vomiting, a ring or feeling of a mortgaging in ears, disturbance of breath up to an apnoea).
Treatment: for lifting the siege of neuromuscular transfer and its effects - a hemodialysis or peritoneal dialysis, antikholinesterazny means, calcium salts, artificial ventilation of the lungs, other symptomatic and maintenance therapy.
Storage conditions:
To store in the dry, protected from light place, at a temperature not above 25 °C.
To store in the place, unavailable to children!
Issue conditions:
According to the recipe
Packaging:
On 1,0 g of active agent in bottles.
On 100 bottles pack into a film.
Put the approved instructions on a medical use in packaging in the state and Russian languages.
