Toxicity of streptomycin

Abstract

The administration of streptomycin by the intramuscular route in a daily dose between 1 and 3 Gm. is well tolerated for a one or two-week period by most individuals. With the single exception of vestibular dysfunction the same close regimens are well tolerated by most individuals for periods as long as four months. Although daily doses larger than 3 Gm. are apparently well tolerated by some individuals for short periods of time, it is probable that 3 Gm. represents the upper limit of the safe daily dose. The histamine reaction, irritation at the site of injection and possibly the sustained febrile reactions are not caused by streptomycin but by impurities which are removable with refinements in the process of manufacture. All of the other manifestations of toxicity which have been observed after the use of impure streptomycin have also occurred during the administration of highly purified preparations of the drug. The toxicity of streptomycin is sufficiently low to justify the use of the drug in serious or potentially serious infections. Conversely, the incidence of toxicity, notably vestibular dysfunction, is sufficiently high after several or more weeks of therapy, that the drug should not be used for infections with a generally favorable prognosis such as. minimal pulmonary tuberculosis or chronic brucellosis.