Therapeutic Uses

Bacterial Endocarditis Streptomycin and penicillin in combination are synergistically bactericidal in vitro against strains of enterococci, group D streptococci, and the various oral streptococci of the viridans group. A combination of penicillin G and streptomycin may be indicated for treatment of streptococcal or enterococcal endocarditis. Streptomycin largely has been replaced by gentamicin but may still be used when the strain is resistant to gentamicin and susceptible to streptomycin.

Tularemia Streptomycin (or gentamicin) is the drug of choice for the treatment of tularemia. Most cases respond to the administration of 1 g (15-25 mg/kg) streptomycin per day (in divided doses) for 7-10 days. Fluoroquinolones and tetracyclines also are effective.

Plague Streptomycin is effective for the treatment of all forms of plague. The recommended dose is 2 g/day in two divided doses for 7-10 days. Gentamicin is probably as efficacious.

Tuberculosis In the treatment of tuberculosis, streptomycin always should be used in combination with at least one or two other drugs to which the causative strain is susceptible (see Chapter 47).

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