Streptomycinis indicated for the treatment of individuals with moderate to severeinfections caused by susceptible strains of microorganisms in the specificconditions listed below:
1.Mycobacterium Tuberculosis: The Advisory Council for the Elimination ofTuberculosis, the American Thoracic Society, and the Center for Disease Controlrecommend that either streptomycin or ethambutol be added as a fourth drug in aregimen containing isoniazid (INH), rifampin and pyrazinamide for initialtreatment of tuberculosis unless the likelihood of INH or rifampin resistanceis very low. The need for a fourth drug should be reassessed when the resultsof susceptibility testing are known. In the past when the national rate ofprimary drug resistance to isoniazid was known to be less than 4% and waseither stable or declining, therapy with two and three drug regimens wasconsidered adequate. If community rates of INH resistance are currently lessthan 4%, an initial treatment regimen with less than four drugs may be considered.
Streptomycinis also indicated for therapy of tuberculosis when one or more of the abovedrugs is contraindicated because of toxicity or intolerance. The management oftuberculosis has become more complex as a consequence of increasing rates ofdrug resistance and concomitant HIV infection. Additional consultation fromexperts in the treatment of tuberculosis may be desirable in those settings.
2.Non-tuberculosis infections: The use of streptomycin should be limited to thetreatment of infections caused by bacteria which have been shown to besusceptible to the antibacterial effects of streptomycin and which are notamenable to therapy with less potentially toxic agents.
Calymmatobacteriumgranulomatis (donovanosis, granuloma inguinale),
H.influenzae (in respiratory, endocardial, and meningeal infections–concomitantlywith another antibacterial agent),
K.pneumoniae pneumonia (concomitantly with another antibacterial agent),
E. coli,Proteus, A. aerogenes, K. pneumoniae, and Enterococcus faecalis in urinarytract infections,
Streptococcusviridans, Enterococcus faecalis (in endocardial infections–concomitantly withpenicillin),
Gram-negativebacillary bacteremia (concomitantly with another antibacterial agent).
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