Streptomycin

How it works

It binds the bacterial 30S ribosomal subunit, causing misreading of messenger RNA and inhibition of protein synthesis, which is bactericidal.

Prescribing in practice

• Streptomycin is both ototoxic and nephrotoxic; ototoxicity, including vestibular damage, may be irreversible, so monitor closely and avoid concurrent ototoxic or nephrotoxic drugs where possible.
• It is given by intramuscular (or supervised intravenous) injection and is used as part of combination antimicrobial regimens.
• Use cautiously in renal impairment and in older adults, who are at greater risk of toxicity.

Monitoring

Monitor renal function, serum drug concentrations where available, and audiological and vestibular function during treatment.

Counselling the patient

• Report any hearing loss, ringing in the ears, dizziness or unsteadiness immediately.
• This antibiotic is given by injection as part of a combination of medicines.
• Tell your clinician about any kidney problems or other medicines affecting the kidneys or hearing.

Evidence & guidelines

Streptomycin's role in tuberculosis and its dose-related oto- and nephrotoxicity are well established in WHO and UK guidance.