Streptomycin and Liver Injury

Streptomycin's Safety Profile in Liver Disease

The CDC and American Thoracic Society guidelines on tuberculosis treatment state that streptomycin requires no precautions when used in patients with hepatic disease 1
Unlike other anti-tuberculosis medications, streptomycin has no documented hepatotoxic effects, according to the American Thoracic Society 2
Streptomycin is primarily eliminated by the kidneys rather than metabolized by the liver, which explains its lack of hepatotoxicity, as noted by the CDC 3

Ototoxicity is the most important adverse reaction, including vestibular and hearing disturbances, with increased risk in elderly patients and those using loop diuretics, according to the American Thoracic Society 1
Nephrotoxicity occurs in approximately 2% of patients, though less commonly than with other aminoglycosides, as reported by the CDC 1
Neurotoxicity can manifest as circumoral paresthesias after injection and rarely as interactions with muscle relaxants causing respiratory muscle weakness, according to the American Thoracic Society 2

No liver function monitoring is required when using streptomycin, as stated by the CDC 4
Baseline and periodic monitoring should focus on audiogram and vestibular testing at baseline, according to the American Thoracic Society 1
Serum creatinine measurement at baseline and monthly is recommended by the CDC 2
Regular assessment for auditory or vestibular symptoms is advised by the American Thoracic Society 4

Streptomycin is contraindicated in pregnancy due to risk of fetal hearing loss, as noted by the CDC 1
Dosage adjustments are essential in patients with renal insufficiency but not in those with liver disease, according to the American Thoracic Society 3
For adults, the standard dose is 15 mg/kg per day, reduced to 10 mg/kg for patients over 59 years of age, as recommended by the CDC 2
In patients with renal insufficiency, dosing frequency should be reduced to 2-3 times weekly while maintaining the 12-15 mg/kg per dose, according to the American Thoracic Society 1

When treating tuberculosis in patients with underlying liver disease, streptomycin can be safely used without concern for worsening hepatic function, as stated by the CDC and American Thoracic Society 1, 2
Monitoring should focus on renal function and ototoxicity rather than hepatic parameters when using streptomycin, according to the CDC 4