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yet</button><a id="jr-fip-next" class="wsprkl btn" title="Jump to next match">▶</a></nav></nav></div><div id="jr-epub-interstitial" class="hidden"></div><div id="jr-content"><article data-type="main"><div class="main-content lit-style" itemscope="itemscope" itemtype="http://schema.org/CreativeWork"><div class="meta-content fm-sec"><div class="fm-sec"><h1 id="_NBK548821_"><span class="title" itemprop="name">Streptomycin</span></h1><p class="fm-aai"><a href="#_NBK548821_pubdet_">Publication Details</a></p></div></div><div class="body-content whole_rhythm" itemprop="text"><div id="Streptomycin.OVERVIEW"><h2 id="_Streptomycin_OVERVIEW_">OVERVIEW</h2><div id="Streptomycin.Introduction"><h3>Introduction</h3><p>Streptomycin is a broad spectrum aminoglycoside antibiotic typically used for treatment of active tuberculosis, always in combination with other antituberculosis agents. Streptomycin is usually used in combination with agents that are known to be hepatotoxic and the role of streptomycin in liver injury has been difficult to assess, but most information suggests that streptomycin is not hepatotoxic.</p></div><div id="Streptomycin.Background"><h3>Background</h3><p>Streptomycin (strep" toe mye' sin), an aminoglycoside antibiotic, must be given by parenteral injection and is now considered a second line antituberculosis agent, used largely when toxicity has limited use of first line agents. Like other aminoglycosides, streptomycin is thought to act by binding to bacterial ribosomes and inhibiting protein synthesis. Nevertheless, streptomycin is considered bacteriocidal as well as bacteriostatic. Streptomycin was approved for use in the United States in 1956, but its use for most indications has been replaced by more modern aminoglycoside antibiotics. Streptomycin is available in vials and as lyophilized powder for injection in multiple generic formulations. The typical adult dose is 15 mg/kg per day (1 gram daily) intramuscularly or intravenously, usually for the first 2 to 4 months of antituberculosis therapy only. The dose must be modified based upon renal function. Streptomycin is also effective against several other bacterial infections but its use is generally limited to cases in which conventional, less toxic antibiotics have been ineffective. Common side effects are auditory and renal dysfunction, and routine monitoring with of kidney function and hearing is recommended. Less common but potentially severe adverse reactions include rash, fever, neurologic toxicity, C. difficile associated diarrhea, and acute hypersensitivity reactions.</p></div><div id="Streptomycin.Hepatotoxicity"><h3>Hepatotoxicity</h3><p>Intravenous and intramuscular therapy with streptomycin has been linked to mild and asymptomatic elevations in serum alkaline phosphatase, but therapy rarely affects aminotransferase levels or bilirubin and changes typically resolve rapidly once streptomycin is stopped. Only isolated case reports of acute liver injury with jaundice have been associated with streptomycin therapy and always in combination with other antituberculosis medications which are more clearly hepatotoxic, such as isoniazid, pyrazinamide and rifampin. Streptomycin and the aminoglycosides are not mentioned in large case series of drug induced liver disease and acute liver failure; thus, hepatic injury from streptomycin must be exceedingly rare, if it occurs at all.</p><p>Likelihood score: E (unlikely cause of clinically apparent liver injury).</p></div><div id="Streptomycin.Mechanism_of_Injury"><h3>Mechanism of Injury</h3><p>Uptake of aminoglycosides into hepatocytes is limited and they are rapidly excreted in the urine; high concentrations are found in mainly in renal tubular cells and hair cells of the inner ear, perhaps explaining why they are more likely to cause nephro- or oto- rather than hepatotoxicity.</p><p>[First line medications used in the therapy of tuberculosis in the US include ethambutol, isoniazid, pyrazinamide, rifabutin, rifampin, and rifapentine. Second line medications include streptomycin, capreomycin, cycloserine, ethionamide, fluoroquinolones such as levofloxacin and moxifloxacin, aminoglycosides such as amikacin, and para-aminosalicylic acid (PAS).]</p><p>Drug Class: <a href="/books/n/livertox/AntituberculosisAgen/?report=reader">Antituberculosis Agents</a>, <a href="/books/n/livertox/Aminoglycosides/?report=reader">Aminoglycosides</a></p><p>Other Drugs in the Class: <a href="/books/n/livertox/Bedaquiline/?report=reader">Bedaquiline</a>, <a href="/books/n/livertox/Capreomycin/?report=reader">Capreomycin</a>, <a href="/books/n/livertox/Cycloserine/?report=reader">Cycloserine</a>, <a href="/books/n/livertox/Ethambutol/?report=reader">Ethambutol</a>, <a href="/books/n/livertox/Ethionamide/?report=reader">Ethionamide</a>, <a href="/books/n/livertox/Isoniazid/?report=reader">Isoniazid</a>, <a href="/books/n/livertox/Pyrazinamide/?report=reader">Pyrazinamide</a>, <a href="/books/n/livertox/Rifabutin/?report=reader">Rifabutin</a>, <a href="/books/n/livertox/Rifampin/?report=reader">Rifampin</a>, <a href="/books/n/livertox/Rifapentine/?report=reader">Rifapentine</a></p></div></div><div id="Streptomycin.PRODUCT_INFORMATION"><h2 id="_Streptomycin_PRODUCT_INFORMATION_">PRODUCT INFORMATION</h2><p>
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<b>REPRESENTATIVE TRADE NAMES</b>
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</p><p>Streptomycin – Generic</p><p>
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<b>DRUG CLASS</b>
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</p><p>Antituberculosis Agents</p><p>
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<a href="https://dailymed.nlm.nih.gov/dailymed/search.cfm?labeltype=all&query=streptomycin" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">COMPLETE LABELING</a>
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</p><p>Product labeling at DailyMed, National Library of Medicine, NIH</p></div><div id="Streptomycin.CHEMICAL_FORMULA_AND_STRUCT"><h2 id="_Streptomycin_CHEMICAL_FORMULA_AND_STRUCT_">CHEMICAL FORMULA AND STRUCTURE</h2><div class="iconblock whole_rhythm clearfix ten_col table-wrap" id="figStreptomycinTc"><a href="/books/NBK548821/table/Streptomycin.Tc/?report=objectonly" target="object" title="Table" class="img_link icnblk_img figpopup" rid-figpopup="figStreptomycinTc" rid-ob="figobStreptomycinTc"><img class="small-thumb" src="/books/NBK548821/table/Streptomycin.Tc/?report=thumb" src-large="/books/NBK548821/table/Streptomycin.Tc/?report=previmg" alt="Image " /></a><div class="icnblk_cntnt"><h4 id="Streptomycin.Tc"><a href="/books/NBK548821/table/Streptomycin.Tc/?report=objectonly" target="object" rid-ob="figobStreptomycinTc">Table</a></h4></div></div></div><div id="Streptomycin.ANNOTATED_BIBLIOGRAPHY"><h2 id="_Streptomycin_ANNOTATED_BIBLIOGRAPHY_">ANNOTATED BIBLIOGRAPHY</h2><p>References updated: 15 September 2021</p><ul class="first-line-outdent"><li><div class="bk_ref" id="Streptomycin.REF.zimmerman.1999">Zimmerman HJ. Antituberculosis agents. In, Zimmerman HJ. Hepatotoxicity: the adverse effects of drugs and other chemicals on the liver. 2nd ed. Philadelphia: Lippincott, 1999, pp. 611-21.<div><i>(Extensive review of hepatotoxicity of antituberculosis medications published in 1999: “Nevertheless, use of streptomycin alone provided data that seem to exonerate it from a hepatotoxic role”).</i></div></div></li><li><div class="bk_ref" id="Streptomycin.REF.verma.2013">Verma S, Kaplowitz N. Hepatotoxicity of antituberculosis drugs. In, Kaplowitz N, DeLeve LD, eds. Drug-induced liver disease. 3rd ed. Amsterdam: Elsevier, 2013, pp. 483-504.<div><i>(Review of hepatotoxicity of antituberculosis drugs).</i></div></div></li><li><div class="bk_ref" id="Streptomycin.REF.gumbo.2018">Gumbo T. Chemotherapy of tuberculosis, mycobacterium avium complex disease and leprosy. In, Brunton LL, Hilal-Dandan R, Knollman BC, eds. Goodman & Gilman’s the pharmacological basis of therapeutics. 13th ed. New York: McGraw-Hill, 2018, pp. 1067-86.<div><i>(Textbook of pharmacology and therapeutics).</i></div></div></li><li><div class="bk_ref" id="Streptomycin.REF.gillis.1960.99">Gillis S, Texler K. Unusual reactions to anti-tuberculous chemotherapy. <span><span class="ref-journal">Med J Aust. </span>1960;<span class="ref-vol">47</span>:99–101.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/13850127" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 13850127</span></a>]<div>
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<i>(36 year old woman treated for tuberculosis with PAS, isoniazid and streptomycin developed rash after 6 days, resolving with stopping PAS but subsequently developed fever and jaundice [bilirubin 5.0 mg/dL], resolving with stopping isoniazid; PAS rechallenge induced rash, but no liver test abnormalities).</i>
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</div></div></li><li><div class="bk_ref" id="Streptomycin.REF.smith.1966.245">Smith JM, Springett VH. Serum transaminase levels during treatment with isoniazid. <span><span class="ref-journal">Tubercle. </span>1966;<span class="ref-vol">47</span>:245–9.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/5971411" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 5971411</span></a>]<div>
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<i>(Among 15 patients with drug rash attributed to PAS, 40% had ALT elevations compared to only 1 of 10 with rash attributed to streptomycin).</i>
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</div></div></li><li><div class="bk_ref" id="Streptomycin.REF.osullivan.1966.221">O'Sullivan DC. Isoniazid jaundice during the treatment of genitourinary tuberculosis. <span><span class="ref-journal">Tubercle. </span>1966;<span class="ref-vol">47</span>:221–4.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/6007094" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 6007094</span></a>]<div>
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<i>(44 year old man developed fever and body aches 3 weeks after starting PAS, streptomycin and isoniazid, followed by rash and jaundice [bilirubin 3.0 mg/dL, AST 120 U/L]; restarting isoniazid led to fever, abdominal pain and rise in ALT, restarting PAS led to fever and rash).</i>
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</div></div></li><li><div class="bk_ref" id="Streptomycin.REF.mor.1990.135">Mor F, Leibovici L, Cohen O, Wysenbeek AJ. Prospective evaluation of liver function tests in patients treated with aminoglycosides. <span><span class="ref-journal">DICP. </span>1990;<span class="ref-vol">24</span>:135–7.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/2309507" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 2309507</span></a>]<div>
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<i>(Prospective study in 104 patients given gentamicin and 10 given amikacin found no change in ALT, LDH or bilirubin levels, but mild increases in Alk P in 23% of patients; no symptomatic hepatitis).</i>
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</div></div></li><li><div class="bk_ref" id="Streptomycin.REF.lindblad.1994.201">Lindblad A, Hultcrantz R, Strandvik B. High doses of aminoglycosides did not produce liver toxicity in patients with cystic fibrosis. <span><span class="ref-journal">J Hepatol. </span>1994;<span class="ref-vol">20</span>:201–5.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/8006400" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 8006400</span></a>]<div>
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<i>(Five patients with cystic fibrosis underwent yearly liver biopsies; those on intermittent aminoglycoside therapy showed no hepatic abnormalities and liver tests were normal in all).</i>
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</div></div></li><li><div class="bk_ref" id="Streptomycin.REF.nassberger.1994.1156">Nassberger L, DePierre J. High doses of aminoglycoside antibiotics do not induce liver toxicity because uptake is limited. <span><span class="ref-journal">J Hepatol. </span>1994;<span class="ref-vol">21</span>:1156.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/7699252" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 7699252</span></a>]<div>
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<i>(Letter in response to Lindblad [1994] postulating that lack of hepatic injury is due to limited uptake of aminoglycosides in the liver compared to kidney and inner ear).</i>
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</div></div></li><li><div class="bk_ref" id="Streptomycin.REF.ormerod.1996.37">Ormerod LP, Horsfield N. Frequency and type of reactions to antituberculosis drugs: observations in routine treatment. <span><span class="ref-journal">Tuber Lung Dis. </span>1996;<span class="ref-vol">77</span>:37–42.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/8733412" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 8733412</span></a>]<div>
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<i>(Among 1317 patients treated for active tuberculosis, hepatitis was attributed to rifampin in 1.4%, pyrazinamide in 1.2% and isoniazid in 0.3%, but none to ethambutol or streptomycin).</i>
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</div></div></li><li><div class="bk_ref" id="Streptomycin.REF.american_thoracic_society.2003.1">American Thoracic Society. CDC; Infectious Diseases Society of America. Treatment of tuberculosis. <span><span class="ref-journal">MMWR Recomm Rep. </span>2003;<span class="ref-vol">52</span>(RR-11):1–77.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/12836625" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 12836625</span></a>]<div>
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<i>(Recommendations for therapy of tuberculosis including details of drug regimens, side effects, monitoring and optimal approaches to follow up; streptomycin is considered a second line drug for treatment of tuberculosis, requiring parenteral injections and monitoring for renal and ototoxicity, given typically during first 2 months of therapy when drug resistant mycobacterial infection is suspected and now largely replaced by ethambutol).</i>
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</div></div></li><li><div class="bk_ref" id="Streptomycin.REF.chalasani.2008.1924">Chalasani N, Fontana RJ, Bonkovsky HL, Watkins PB, Davern T, Serrano J, Yang H, Rochon J., Drug Induced Liver Injury Network (DILIN). Causes, clinical features, and outcomes from a prospective study of drug-induced liver injury in the United States. <span><span class="ref-journal">Gastroenterology. </span>2008;<span class="ref-vol">135</span>:1924–34.</span> [<a href="/pmc/articles/PMC3654244/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC3654244</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/18955056" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 18955056</span></a>]<div>
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<i>(Among 300 cases of drug induced liver disease in the US collected from 2004 to 2008, 1 case was attributed to gentamicin, but none to streptomycin).</i>
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</div></div></li><li><div class="bk_ref" id="Streptomycin.REF.abubakar.2009.512">Abubakar I, Moore J, Drobniewski F, Kruijshaar M, Brown T, Yates M, Anderson C, et al. Extensively drug-resistant tuberculosis in the UK: 1995 to 2007. <span><span class="ref-journal">Thorax. </span>2009;<span class="ref-vol">64</span>:512–5.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/19318348" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 19318348</span></a>]<div>
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<i>(Among 678 extensively drug resistant isolates of tuberculosis reported in the UK between 2005 and 2008, 3.4% were also resistant to capreomycin and 51% to streptomycin).</i>
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</div></div></li><li><div class="bk_ref" id="Streptomycin.REF.reuben.2010.2065">Reuben A, Koch DG, Lee WM., Acute Liver Failure Study Group. Drug-induced acute liver failure: results of a U.S. multicenter, prospective study. <span><span class="ref-journal">Hepatology. </span>2010;<span class="ref-vol">52</span>:2065–76.</span> [<a href="/pmc/articles/PMC3992250/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC3992250</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/20949552" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 20949552</span></a>]<div>
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<i>(Among 1198 patients with acute liver failure enrolled in a US prospective study between 1998 and 2007, 133 were attributed to drug induced liver injury and 25 to antituberculosis agents, including 15 to isoniazid alone [ranking first], 6 to isoniazid combined with other agents, 3 to rifampin and pyrazinamide and 1 to dapsone, but none to streptomycin or other aminoglycosides).</i>
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</div></div></li><li><div class="bk_ref" id="Streptomycin.REF.devarbhavi.2010.2396">Devarbhavi H, Dierkhising R, Kremers WK, Sandeep MS, Karanth D, Adarsh CK. Single-center experience with drug-induced liver injury from India: causes, outcome, prognosis, and predictors of mortality. <span><span class="ref-journal">Am J Gastroenterol. </span>2010;<span class="ref-vol">105</span>:2396–404.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/20648003" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 20648003</span></a>]<div>
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<i>(Among 313 cases of drug induced liver injury seen between 1997 and 2008 at a large hospital in Bangalore, India, 181 [58%] were attributed to antituberculosis agents, which accounted for 39 of 54 [72%] fatal cases; streptomycin and aminoglycosides were not specifically mentioned).</i>
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</div></div></li><li><div class="bk_ref" id="Streptomycin.REF.arbex.2010.641">Arbex MA, Varella Mde C, Siqueira HR, Mello FA. Antituberculosis drugs: drug interactions, adverse effects, and use in special situations. Part 2: second line drugs. <span><span class="ref-journal">J Bras Pneumol. </span>2010;<span class="ref-vol">36</span>:641–56.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/21085831" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 21085831</span></a>]<div>
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<i>(Analysis of adverse effects of second line drugs for tuberculosis; the aminoglycosides [streptomycin, amikacin and kanamycin] are second line agents for tuberculosis and side effects include ototoxicity, neurotoxicity, nephrotoxicity, neuormuscular blockade and hypersensitivity reactions; hepatotoxicity not mentioned).</i>
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</div></div></li><li><div class="bk_ref" id="Streptomycin.REF.caminero.2010.621">Caminero JA, Sotgiu G, Zumla A, Migliori GB. Best drug treatment for multidrug-resistant and extensively drug-resistant tuberculosis. <span><span class="ref-journal">Lancet Infect Dis. </span>2010;<span class="ref-vol">10</span>:621–9.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/20797644" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 20797644</span></a>]<div>
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<i>(Recommends that treatment of multidrug resistant tuberculosis should always include an injectable drug, the first choice being capreomycin, others being the aminoglycosides streptomycin, kanamycin and amikacin).</i>
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</div></div></li><li><div class="bk_ref" id="Streptomycin.REF.chalasani.2015.1340">Chalasani N, Bonkovsky HL, Fontana R, Lee W, Stolz A, Talwalkar J, Reddy KR, et al. United States Drug Induced Liver Injury Network. Features and outcomes of 899 patients with drug-induced liver injury: The DILIN Prospective Study. <span><span class="ref-journal">Gastroenterology. </span>2015;<span class="ref-vol">148</span>:1340–52.</span> [<a href="/pmc/articles/PMC4446235/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC4446235</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/25754159" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 25754159</span></a>]<div>
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<i>(Among 899 cases of drug induced liver injury enrolled in a US prospective study between 2004 and 2013, 53 [6%] implicated drugs for tuberculosis including 48 attributed to isoniazid, but none to streptomycin).</i>
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</div></div></li><li><div class="bk_ref" id="Streptomycin.REF.li.2015.e1665">Li X, Liu Y, Zhang E, He Q, Tang YB. Liver transplantation in antituberculosis drugs-induced fulminant hepatic failure: a case report and review of the literature. <span><span class="ref-journal">Medicine (Baltimore). </span>2015;<span class="ref-vol">94</span>:e1665. </span> [<a href="/pmc/articles/PMC5008466/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC5008466</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/26656321" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 26656321</span></a>]<div>
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<i>(39 year old woman developed jaundice 3 months after starting isoniazid, rifampin, and pyrazinamide for latent tuberculosis [bilirubin 9.6 rising to 31.2 mg/dL, ALT 388 U/L, Alk P not given, prothrombin time 74 sec], with progressive hepatic insufficiency leading to liver transplant 4 months later followed by steroid-resistant graft rejection, worsening hepatic function, infections and death from multiorgan failure one year later while being treated with ethambutol, moxifloxacin and streptomycin for tuberculosis).</i>
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</div></div></li><li><div class="bk_ref" id="Streptomycin.REF.garciaprats.2016.1491">Garcia-Prats AJ, Schaaf HS, Hesseling AC. The safety and tolerability of the second-line injectable antituberculosis drugs in children. <span><span class="ref-journal">Expert Opin Drug Saf. </span>2016;<span class="ref-vol">15</span>:1491–1500.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/27548570" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 27548570</span></a>]<div>
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<i>(Review of the second line injectable drugs for tuberculosis including capreomycin, discusses ototoxicity, nephrotoxicity, electrolyte disturbances, local injection site reactions, but not hepatotoxicity).</i>
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</div></div></li><li><div class="bk_ref" id="Streptomycin.REF.nataprawira.2021.e930828">Nataprawira HM, Aliyannissa A, Febrianti SA. Unusual recurrence of antituberculosis drug-induced hepatotoxicity in children: a case series. <span><span class="ref-journal">Am J Case Rep. </span>2021;<span class="ref-vol">22</span>:e930828. </span> [<a href="/pmc/articles/PMC8295927/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC8295927</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/34267172" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 34267172</span></a>]<div>
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<i>(Among 6 children with recurred liver injury on therapy for tuberculosis, in 4 instances the children tolerated streptomycin and ethambutol after having an initial bout, and redeveloped acute injury with reintroduction of isoniazid).</i>
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</div></div></li><li><div class="bk_ref" id="Streptomycin.REF.garciaprats.2016.1491_1">Garcia-Prats AJ, Schaaf HS, Hesseling AC. The safety and tolerability of the second-line injectable antituberculosis drugs in children. <span><span class="ref-journal">Expert Opin Drug Saf. </span>2016;<span class="ref-vol">15</span>:1491–1500.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/27548570" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 27548570</span></a>]<div>
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<i>(Review of the second line injectable drugs for tuberculosis including streptomycin, discusses ototoxicity, nephrotoxicity, electrolyte disturbances, local injection site reactions, but not hepatotoxicity).</i>
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</div></div></li></ul></div><div id="bk_toc_contnr"></div></div></div><div class="fm-sec"><h2 id="_NBK548821_pubdet_">Publication Details</h2><h3>Publication History</h3><p class="small">Last Update: <span itemprop="dateModified">September 15, 2021</span>.</p><h3>Copyright</h3><div><div class="half_rhythm"><a href="/books/about/copyright/">Copyright Notice</a></div></div><h3>Publisher</h3><p><a href="https://www.niddk.nih.gov/" ref="pagearea=page-banner&targetsite=external&targetcat=link&targettype=publisher">National Institute of Diabetes and Digestive and Kidney Diseases</a>, Bethesda (MD)</p><h3>NLM Citation</h3><p>LiverTox: Clinical and Research Information on Drug-Induced Liver Injury [Internet]. Bethesda (MD): National Institute of Diabetes and Digestive and Kidney Diseases; 2012-. Streptomycin. [Updated 2021 Sep 15].<span class="bk_cite_avail"></span></p></div><div class="small-screen-prev"><a href="/books/n/livertox/Stiripentol/?report=reader"><svg xmlns="http://www.w3.org/2000/svg" viewBox="0 0 100 100" preserveAspectRatio="none"><path d="M75,30 c-80,60 -80,0 0,60 c-30,-60 -30,0 0,-60"></path><text x="20" y="28" textLength="60" style="font-size:25px">Prev</text></svg></a></div><div class="small-screen-next"><a href="/books/n/livertox/Streptozocin/?report=reader"><svg xmlns="http://www.w3.org/2000/svg" viewBox="0 0 100 100" preserveAspectRatio="none"><path d="M25,30c80,60 80,0 0,60 c30,-60 30,0 0,-60"></path><text x="20" y="28" textLength="60" style="font-size:25px">Next</text></svg></a></div></article><article data-type="table-wrap" id="figobStreptomycinTc"><div id="Streptomycin.Tc" class="table"><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK548821/table/Streptomycin.Tc/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__Streptomycin.Tc_lrgtbl__"><table><thead><tr><th id="hd_h_Streptomycin.Tc_1_1_1_1" scope="col" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">DRUG</th><th id="hd_h_Streptomycin.Tc_1_1_1_2" scope="col" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">CAS REGISTRY NUMBER</th><th id="hd_h_Streptomycin.Tc_1_1_1_3" scope="col" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">MOLECULAR FORMULA</th><th id="hd_h_Streptomycin.Tc_1_1_1_4" scope="col" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">STRUCTURE</th></tr></thead><tbody><tr><td headers="hd_h_Streptomycin.Tc_1_1_1_1" scope="row" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Streptomycin</td><td headers="hd_h_Streptomycin.Tc_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<a href="https://pubchem.ncbi.nlm.nih.gov/substance/134971352" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubchem">57-92-1</a>
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</td><td headers="hd_h_Streptomycin.Tc_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">C21-H39-N7-O12</td><td headers="hd_h_Streptomycin.Tc_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<a href="https://pubchem.ncbi.nlm.nih.gov/substance/134971352" title="View this structure in PubChem" class="img_link" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubchem"><img src="https://pubchem.ncbi.nlm.nih.gov/image/imgsrv.fcgi?t=l&sid=134971352" alt="image 134971352 in the ncbi pubchem database" /></a>
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