Tonomycin Powder for Injection

Streptomycin is indicated for the treatment of individuals with moderate to severe infections caused by susceptibile strains of microorganisms in the specific conditions listed below: 1. Mycobacterium tuberculosis: The Advisory Council for the Elimination of Tuberculosis, the American Thoracic Society, and the Center for Disease Control recommend that either streptomycin or ethambutol be added as a fourth drug in a regimen containing isoniazid (INH), rifampin and pyrazinamide for initial treatment of tuberculosis unless the likelihood of INH or rifampin resistance is very low. The need for a fourth drug should be reassessed when the results of susceptibility testing are known. …

• Intramuscular Route Only
• Adults: The preferred site is the upper outer quadrant of the buttock (i.e., gluteus maximus) or the mid-lateral thigh
• Children: It is recommended that intramuscular injections be given preferably in the mid-lateral muscles of the thigh
• In infants and small children the periphery of the upper outer quadrant of the gluteal region should be used only when necessary, such as in burn patients, in order to minimize the possibility of damage to the sciatic nerve
• The deltoid area should be used only if well developed, such as in certain
• Adults and older children, and then only with caution to avoid radial nerve injury
• Intramuscular injections should not be made into the lower and mid-third of the upper arm
• As with all intramuscular injections, aspiration is necessary to help avoid inadvertent injection into a blood vessel
• Injection sites should be alternated
• As higher doses or more prolonged therapy with streptomycin may be indicated for more severe or fulminating infections (endocarditis, meningitis, etc.), the physician should always take adequate measures to be immediately aware of any toxic signs or symptoms occurring in the patient as a result of streptomycin therapy. 1
• TUBERCULOSIS: The standard regimen
• For the treatment of drug susceptible tuberculosis has been two months of INH, rifampin and pyrazinamide followed by four months of INH and rifampin (patients with concomitant infection with tuberculosis and HIV may require treatment for a longer period). …

See DOSAGE AND ADMINISTRATION .

• Patients should be counseled that antibacterial drugs including streptomycin should only be used to treat bacterial infections
• They do not treat viral infections (e.g., the common cold)
• When streptomycin is prescribed to treat a bacterial infection, patients should be told that although it is common to feel better early in the course of therapy, the medication should be taken exactly as directed
• Skipping doses or not completing the full course of therapy may decrease the effectiveness of the immediate treatment and increase the likelihood that bacteria will develop resistance and will not be treatable by streptomycin or other antibacterial drugs in the future. …

• A history of clinically significant hypersensitivity to streptomycin is a contraindication to its use
• Clinically significant hypersensitivity to other aminoglycosides may contraindicate the use of streptomycin because of the known cross-sensitivity of patients to drugs in this class

The ototoxic effects of the aminoglycosides, including streptomycin, are potentiated by the coadministration of ethacrynic acid, furosemide, mannitol and possibly other diuretics.

Ototoxicity Both vestibular and auditory dysfunction can follow the administration of streptomycin. The degree of impairment is directly proportional to the dose and duration of streptomycin administration, to the age of the patient, to the level of renal function and to the amount of underlying existing auditory dysfunction. The ototoxic effects of the aminoglycosides, including streptomycin, are potentiated by the co-administration of ethacrynic acid, mannitol, furosemide and possibly other diuretics. The vestibulotoxic potential of streptomycin exceeds that of its capacity for cochlear toxicity. Vestibular damage is heralded by headache, nausea, vomiting and disequilibrium. …

The following reactions are common: vestibular ototoxicity (nausea, vomiting, and vertigo); paresthesia of face; rash; fever; urticaria; angioneurotic edema; and eosinophilia. The following reactions are less frequent: cochlear ototoxicity (deafness); exfoliative dermatitis; anaphylaxis; azotemia; leucopenia; thrombocytopenia; pancytopenia; hemolytic anemia; muscular weakness; and amblyopia. Vestibular dysfunction resulting from the parenteral administration of streptomycin is cumulatively related to the total daily dose. …

Pregnancy See WARNINGS section.

Take it when you remember, unless it is nearly time for the next dose. Then skip the missed one. Never take two doses at once to make up for it. Check your leaflet, as some medicines are different.