Streptomycin (Streptomycin Sulfate)
Also sold as: Streptomycin Sulfate IP, Streptomycin BP
Pregnancy
Cat D
Lactation
Caution
Schedule
H1
Forms
Injection 1 g vial (for IM use) +1
Indications
- Tuberculosis — second-line injectable (MDR-TB or when oral agents not tolerated)
- Brucellosis (with doxycycline)
- Plague (Yersinia pestis)
- Tularaemia
- Bacterial endocarditis (adjunct — with penicillin, for streptococcal/enterococcal)
Adult Dosing
Tuberculosis (second-line injectable — MDR-TB or oral intolerance)
15 mg/kg IM OD (max 1 g/day)
Daily for 2–3 months (intensive phase of MDR-TB regimen)
Standard practical dose: 750 mg–1 g IM OD; rotate injection sites; give deep IM — never IV; patients >59 years: max 750 mg/day
Brucellosis
1 g IM OD
14–21 days (with oral doxycycline 100 mg BD x6 weeks)
Preferred combination for severe brucellosis including spondylitis
Plague (Yersinia pestis)
1 g IM BD
10 days or until 3 days after fever resolves
Drug of choice for plague; gentamicin is an alternative
Pediatric Dosing
Use only when benefits clearly outweigh ototoxicity and nephrotoxicity risks; audiometric monitoring mandatory; avoid in neonates
Renal Dose Adjustment
| CrCl / eGFR | Dose Adjustment |
|---|---|
| CrCl 50–90 mL/min | 7.5 mg/kg q24h |
| CrCl 10–50 mL/min | 7.5 mg/kg q24–72h (based on levels and renal function) |
| CrCl <10 mL/min or haemodialysis | Avoid — significant accumulation and irreversible ototoxicity risk; if essential, seek specialist pharmacokinetic guidance |
Hepatic Adjustment
No dose adjustment required for hepatic impairment — streptomycin is not hepatically metabolised. Standard renal-based dosing applies.
Pregnancy & Lactation
Pregnancy: Category D
AVOID throughout pregnancy. Streptomycin crosses the placenta and can cause irreversible cochlear and vestibular damage to the fetus, resulting in congenital deafness. Use only if no safer alternative exists for life-threatening infection.
Lactation: Caution
Excreted in breast milk in small amounts. Poor oral bioavailability in infant limits systemic absorption. Monitor infant for signs of ototoxicity. Short courses generally acceptable with monitoring.
Top Drug Interactions
| Interacting Drug | Effect | Severity |
|---|---|---|
| Loop diuretics (furosemide, ethacrynic acid) | Additive ototoxicity — significantly increases risk of irreversible hearing loss; avoid combination; if unavoidable, use lowest possible doses with close audiometric monitoring | Major |
| Other aminoglycosides (gentamicin, amikacin) | Additive nephrotoxicity and ototoxicity — never combine aminoglycosides; sequential use with washout period if switching | Major |
| Neuromuscular blocking agents (vecuronium, atracurium) | Streptomycin enhances neuromuscular blockade — may cause prolonged paralysis and respiratory depression; avoid combination; if used in anaesthesia, have reversal agents ready | Major |
| NSAIDs (especially indomethacin) | Reduces renal clearance of aminoglycosides — increases aminoglycoside serum levels and nephrotoxicity risk | Moderate |
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Side Effects
Common
- Pain and induration at injection site
- Nausea, vomiting
- Dizziness, vertigo (vestibular toxicity — early sign)
- Tinnitus (early cochlear toxicity warning)
- Headache, perioral paraesthesia after injection
Serious / Discontinue If
- OTOTOXICITY — IRREVERSIBLE: vestibular toxicity (dizziness, vertigo, ataxia — often occurs first) and cochlear toxicity (sensorineural hearing loss — high-frequency first); risk is cumulative and dose-dependent
- Nephrotoxicity — acute tubular necrosis; monitor renal function; usually reversible if caught early
- Neuromuscular blockade — respiratory paralysis (especially with concurrent neuromuscular blockers or myasthenia gravis)
- Severe hypersensitivity/anaphylaxis (rare)
- Blood dyscrasias — aplastic anaemia, agranulocytosis (rare)
Contraindications
- Pre-existing significant hearing loss or labyrinthine disease
- Myasthenia gravis (relative — severe neuromuscular blockade risk)
- Pregnancy (Category D — fetal ototoxicity)
- Severe renal impairment (CrCl <10 mL/min)
- Hypersensitivity to streptomycin or other aminoglycosides
- IV administration — IM only; IV use causes severe neurotoxicity
Available Indian Brands
| Brand | Manufacturer | Price (approx) |
|---|---|---|
| Streptomycin 1g vial | IPCA | ₹45/vial |
| Streptomycin BP 0.75g | Cadila | ₹38/vial |
Monitoring Required
- Baseline renal function (serum creatinine, BUN, eGFR) before starting — MANDATORY
- Renal function weekly during treatment; dose-adjust immediately if creatinine rises
- Baseline audiometry (pure-tone audiogram) before starting — MANDATORY
- Audiometry monthly during treatment; STOP IMMEDIATELY if hearing loss detected
- Vestibular function assessment — ask about dizziness/vertigo at every visit
- Peak and trough serum streptomycin levels where available (peak 25–40 mcg/mL; trough <5 mcg/mL)
- Rotate IM injection sites — document site each dose
Patient Counseling Points
- This medicine is given as an injection into the muscle — never into a vein
- Report immediately: any dizziness, ringing in ears (tinnitus), hearing changes, or difficulty walking straight — these are early warning signs of nerve damage to your inner ear
- Inner ear damage from this medicine can be permanent — that is why we monitor hearing monthly
- Drink plenty of water during treatment — this helps protect your kidneys
- Tell your doctor about all other medicines you are taking, especially water tablets (diuretics)
- Do not drive or operate heavy machinery if you experience dizziness or balance problems
- If you are pregnant or plan to become pregnant, inform your doctor immediately — this medicine can cause deafness in the unborn baby
- Complete the full prescribed course; never stop without medical advice
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Clinically reviewed by: Dr. Anand Kumar, MD (Pulmonology), Chest Physician, TB & Chest Hospital, New Delhi
Last reviewed: 2026-04-30
References
- WHO Treatment of Drug-Resistant Tuberculosis, 2022
- RNTCP MDR-TB Treatment Guidelines, Central TB Division, MoHFW India
- WHO Model Formulary 2008 — Streptomycin
- Micromedex Drug Interactions — Streptomycin, 2024
- BNF (British National Formulary) — Streptomycin monograph, 2024