streptomycin sulfate 145 streptokinase streptomycin sulfate Kabikinase, Streptase Aminoglycoside; antibiotic Plasminogen activator; thrombolytic PRC: D enzyme PRC: C Available forms Injection: 400 mg/ml; Lyophilized cake/ Available forms powder for injection: 200 mg/ml Injection: 250,000, 750,000, 1,500,000 IU in vials for reconstitution Indications & dosages ➤ TB—Adult: 1 g or 15 mg/kg IM daily, Indications & dosages or 25-30 mg/kg (max 1.5 g) 2-3 times/wk ➤ Arteriovenous cannula occlusion— ϫ ≥ 1 yr. Elderly: Reduce daily dosage Adult: 250,000 IU in 2 ml IV solution in based on age, renal function, and 8th cra- each cannula limb over 25-35 min. Clamp nial nerve function. Suggested dosage cannula 2 hr. Aspirate, flush, and re- 10 mg/kg (max 750 mg) IM daily. Child: connect. 20-40 mg/kg (max 1 g) IM daily, or 25- ➤ Venous thrombosis, PE, arterial throm- 30 mg/kg (max 1.5 g) 2-3 times/wk ≥ bosis and embolism—Adult: 250,000 IU 1yr.† IV over 30 min. Then 100,000 IU/hr IV ϫ ➤ Enterococcal endocarditis—Adult: 1 g 72 hr for DVT and 100,000 IU/hr ϫ 24- IM q 12 hr ϫ 2 wk; then 500 mg IM q 72 hr for PE and arterial thrombosis or 12 hr ϫ 4 wk with a PCN.† embolism. ➤ Tularemia—Adult: 1-2 g IM daily in di- ➤ Lysis of coronary artery thrombi asso- vided doses ϫ 7-14 d or until patient ciated with MI—Adult: 20,000 IU IV bolus afebrile for 5-7 d.† via coronary catheter; then 2,000 IU/min ➤ Plague—Adult: 2 g (30 mg/kg) IM daily infusion over 60 min. Or as IV infusion, in 2 divided doses ≥ 10 d. Child: 30 mg/ usually 1.5 million IU IV over 60 min. kg IM daily in 2-3 divided doses ϫ 10 d.† ➤ Brucellosis—Adult: 1-2 g IM with Interactions doxycycline or tetracycline in divided dos- Aminocaproic acid: May inhibit streptoki- es q 6-12 hr. Child > 8 yr: 20 mg/kg (max nase effects on plasminogen activation. 1 g) IM ϫ 2 wk with a tetracycline.† Anticoagulants: May cause hemorrhage; ➤ PCN-susceptible strep endocarditis— may be necessary to reverse effects of oral Adult ≤ 60 yr: 1 g IM bid ϫ 1wk with a anticoagulants before beginning therapy. PCN. Then 500 mg bid ϫ 1wk. Adult > Aspirin, indomethacin, phenylbutazone, 60 yr: 500 mg bid ϫ 2 wk with a PCN.† other drugs that affect platelet activity: May increase risk of bleeding. Interactions Amphotericin B, capreomycin, cephalo- sporins, cisplatin, methoxyflurane, § Adjust in immunocompromised patients ¶ Adjust in debilitated patients.