Streptomycin

INTRODUCTION

Indications

In combination with other agents in the management of active tuberculosis. In combination with other agents in the management of serious enterococcal or gram-negative infections.

Action

Inhibits protein synthesis in bacteria at level of 30S ribosome. Therapeutic Effects: Bactericidal action. Spectrum: Notable for activity against. Enterococci (synergy with a penicillin is required). Also active against Mycobacterium.

Adverse Reactions/Side Effects

EENT: ototoxicity (vestibular and cochlear). GU: nephrotoxicity. F and E: hypomagnesemia. MS: muscle paralysis (high parenteral doses). Misc: hypersensitivity reactions.

PHYSICAL THERAPY IMPLICATIONS

Examination and Evaluation

• Monitor signs of hypersensitivity reactions, including pulmonary symptoms (tightness in the throat and chest, wheezing, cough dyspnea) or skin reactions (rash, pruritus, urticaria). Notify physician or nursing staff immediately if these reactions occur.

• Report any muscle weakness or paralysis that occurs following injection of high doses.

• Monitor signs of ototoxicity, including hearing loss, tinnitus, and balance problems (See Appendix E for fall assessment and prevention). Report these signs, and caution the patient and family/caregivers to guard against falls and trauma.

• Monitor signs of low magnesium levels (hypomagnesemia), such as lethargy, irritability, insomnia, muscle tremors, and confusion. Notify physician of these signs.

Interventions

• Always wash hands thoroughly and disinfect equipment (whirlpools, electrotherapeutic devices, treatment tables, and so forth) to help prevent the spread of infection. Use universal precautions or isolation procedures as indicated for specific patients.

Patient/Client-Related Instruction

• Advise patient to report signs of nephrotoxicity, including blood or pus in urine, decreased urine output, fatigue, and weight gain from fluid retention.

Pharmacokinetics

Absorption: Well absorbed after IM and intra-peritoneal administration. Negligible absorption when administered orally.

Distribution: Widely distributed throughout extracellular fluid; crosses the placenta; small amounts enter breast milk. Poor penetration into CSF.

Metabolism and Excretion: Excretion is >90% renal.

Half-life: 2–4 hr (increased in renal impairment).

Contraindications/Precautions

Contraindicated in: Hypersensitivity; Cross-sensitivity among aminoglycosides may occur.

Use Cautiously in: Renal impairment (dosage adjustments necessary; blood level monitoring useful in preventing ototoxicity and nephrotoxicity); Hearing impairment; Geriatric patients and premature infants (difficulty in assessing auditory and vestibular function; age-related renal impairment); Neuromuscular diseases such as myasthenia gravis; Obese patients (dosage should be based on ideal body weight); Neonates (increased risk of neuromuscular blockade; difficulty in assessing auditory and vestibular function; immature renal function); Pregnancy ...