Streptomycin is bactericidal for the tubercle bacillus in vitro. The vast majority of strains of M. tuberculosis are sensitive. M. kansasii is frequently sensitive, but other mycobacteria are only occasionally susceptible. Streptomycin in vivo does not eradicate the tubercle bacillus, probably because the drug does not readily enter living cells and thus cannot kill intracellular microbes. The broader pharmacology of streptomycin is covered in chapter 45.
Primary resistance to streptomycin is found in only 2-3% of isolates of M. tuberculosis. Selection for resistant tubercle bacilli occurs in vivo; the longer therapy, the greater the incidence of resistance.
therapeutic uses The use of streptomycin for the treatment of pulmonary tuberculosis has declined sharply. Many clinicians still prefer to give 4 drugs, of which streptomycin may be one, for the most serious forms of tuberculosis, (e.g., disseminated disease or meningitis). Adults should be given 15 mg/kg/day in divided doses given by intramuscular injection every 12 hours, not to exceed 1 g/day. Children should receive 20-40 mg/kg/day in divided doses every 12-24 hours, not to exceed 1 g/day. Therapy usually is discontinued after 2-3 months, or sooner if cultures become negative.
untoward effects In tuberculosis patients treated with streptomycin, 8% had adverse reactions; half of which involved the auditory and vestibular functions of the eighth cranial nerve. other problems included rash and fever.
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