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Drug overview for STREPTOMYCIN SULFATE (streptomycin sulfate):
Generic name: STREPTOMYCIN SULFATE (strep-toe-MYE-sin)
Drug class: Aminoglycosides, Parenteral
Therapeutic class: Anti-Infective Agents
Streptomycin is an aminoglycoside antibiotic and antituberculosis agent.
No enhanced Uses information available for this drug.
Generic name: STREPTOMYCIN SULFATE (strep-toe-MYE-sin)
Drug class: Aminoglycosides, Parenteral
Therapeutic class: Anti-Infective Agents
Streptomycin is an aminoglycoside antibiotic and antituberculosis agent.
No enhanced Uses information available for this drug.
DRUG IMAGES
STREPTOMYCIN SULF 1 GM VIAL
The following indications for STREPTOMYCIN SULFATE (streptomycin sulfate) have been approved by the FDA:
Indications:
Active tuberculosis
Aerobic gram-negative bacteremia
Bacterial urinary tract infection
Brucellosis
E. coli urinary tract infection
Enterobacter cloacae urinary tract infection
Enterococcus urinary tract infection
Granuloma inguinale
H. influenzae meningitis
Haemophilus influenzae pneumonia
Klebsiella urinary tract infection
Plague
Proteus urinary tract infection
Pulmonary tuberculosis
Synergy for enterococcal endocarditis
Synergy for enterococcal infection
Synergy for streptococcal endocarditis
Tularemia
Professional Synonyms:
Active TB
Acute tuberculosis
Deer-fly disease
Deer-fly fever
Donovanosis
E. coli UTI
Fourth venereal disease
Francis' disease
Gram-negative bacteremia
Granuloma venereum
H. flu meningitis
H. flu pneumonia
H. influenzae pneumonia
Haemophilus influenzae meningitis
Hemophilus influenzae pneumonia
Infection due to Calymmatobacterium granulomatis
Influenza Bacillus pneumonia
Influenzae Bacillus meningitis
Klebsiella UTI
Malta fever
Meningitis due to Haemophilus influenzae
Meningitis due to Hemophilus influenzae
Pahvant Valley fever
Pahvant Valley plague
Pfeiffer's Bacillus meningitis
Pfeiffer's Bacillus pneumonia
Pneumonia due to Haemophilus influenzae
Pudendal ulcer
Pulmonary TB
Rabbit fever
Synergy for endocarditis due to Enterococcus
Synergy for endocarditis due to Streptococcus species
Synergy for endocarditis due to Streptococcus spp.
Synergy for infections caused by Enterococcus species
Synergy for infections caused by Enterococcus spp.
Undulant fever
Urinary tract infection due to Enterobacter cloacae
Urinary tract infection due to Enterococcus species
Urinary tract infection due to Escherichia coli
Urinary tract infection due to Klebsiella species
Urinary tract infection due to Proteus species
UTI due to Enterobacter cloacae
UTI due to Enterococcus species
UTI due to Proteus species
Indications:
Active tuberculosis
Aerobic gram-negative bacteremia
Bacterial urinary tract infection
Brucellosis
E. coli urinary tract infection
Enterobacter cloacae urinary tract infection
Enterococcus urinary tract infection
Granuloma inguinale
H. influenzae meningitis
Haemophilus influenzae pneumonia
Klebsiella urinary tract infection
Plague
Proteus urinary tract infection
Pulmonary tuberculosis
Synergy for enterococcal endocarditis
Synergy for enterococcal infection
Synergy for streptococcal endocarditis
Tularemia
Professional Synonyms:
Active TB
Acute tuberculosis
Deer-fly disease
Deer-fly fever
Donovanosis
E. coli UTI
Fourth venereal disease
Francis' disease
Gram-negative bacteremia
Granuloma venereum
H. flu meningitis
H. flu pneumonia
H. influenzae pneumonia
Haemophilus influenzae meningitis
Hemophilus influenzae pneumonia
Infection due to Calymmatobacterium granulomatis
Influenza Bacillus pneumonia
Influenzae Bacillus meningitis
Klebsiella UTI
Malta fever
Meningitis due to Haemophilus influenzae
Meningitis due to Hemophilus influenzae
Pahvant Valley fever
Pahvant Valley plague
Pfeiffer's Bacillus meningitis
Pfeiffer's Bacillus pneumonia
Pneumonia due to Haemophilus influenzae
Pudendal ulcer
Pulmonary TB
Rabbit fever
Synergy for endocarditis due to Enterococcus
Synergy for endocarditis due to Streptococcus species
Synergy for endocarditis due to Streptococcus spp.
Synergy for infections caused by Enterococcus species
Synergy for infections caused by Enterococcus spp.
Undulant fever
Urinary tract infection due to Enterobacter cloacae
Urinary tract infection due to Enterococcus species
Urinary tract infection due to Escherichia coli
Urinary tract infection due to Klebsiella species
Urinary tract infection due to Proteus species
UTI due to Enterobacter cloacae
UTI due to Enterococcus species
UTI due to Proteus species
The following dosing information is available for STREPTOMYCIN SULFATE (streptomycin sulfate):
Dosage of streptomycin sulfate is expressed in terms of streptomycin.
Like other aminoglycosides, dosage of streptomycin should individualized taking into consideration the patient's pretreatment body weight, renal status, severity of the infection, and susceptibility of the causative organism.
Whenever possible, especially in patients with life-threatening infections, suspected toxicity or nonresponse to treatment, decreased or varying renal function, and/or when increased aminoglycoside clearance (e.g., patients with cystic fibrosis, burns) or prolonged therapy is likely, peak and trough serum concentrations of streptomycin should be monitored and dosage adjusted to maintain desired serum concentrations. (See Dosage and Administration: Dosage, in the Aminoglycosides General Statement 8:12.02.) A causal relationship between maintenance of certain peak or trough serum concentrations or other pharmacodynamic endpoints and clinical response or toxicity has not been established to date for streptomycin dosing regimens. However, suggested desirable peak and trough serum concentrations of streptomycin are 5-35 mcg/mL and less than 5-10 mcg/mL, respectively.
Peak serum streptomycin concentrations greater than 40-50 mcg/mL may be associated with toxicity; some clinicians state that persistent concentrations greater than 20 mcg/mL should be avoided. For the treatment of enterococcal endocarditis, the American Heart Association (AHA) and Infectious Diseases Society of America (IDSA) recommend that streptomycin dosage be adjusted to achieve 1-hour peak serum concentrations of 20-35 mcg/mL and trough concentrations less than 10 mcg/mL.
Although streptomycin dosage regimens that involve once-daily (single-daily) dosing are recommended for the treatment of tuberculosis and brucellosis, once-daily streptomycin regimens are not usually recommended for other indications and should not be used for the treatment of enterococcal or streptococcal endocarditis.
If IM streptomycin is used concomitantly with other anti-infectives for the treatment of moderate to severe infections caused by susceptible gram-negative or gram-positive bacteria, the usual adult dosage is 1-2 g daily given in divided doses every 6-12 hours. Streptomycin dosage generally should not exceed 2 g daily.
If IM streptomycin is used concomitantly with other anti-infectives for the treatment of moderate to severe infections caused by susceptible gram-negative or gram-positive bacteria, the usual dosage in children is 20-40 mg/kg daily given in divided doses every 6-12 hours. Particular care should be taken to avoid excessive dosage in children.
A streptomycin dosage of 7.5 mg/kg given IM every 12 hours has been used in neonates.
In patients with impaired renal function, doses and/or frequency of administration of streptomycin must be modified in response to serum concentrations of the drug and the degree of renal impairment. Because of the increased risk of ototoxicity and nephrotoxicity, streptomycin should be used with caution in patients with impaired renal function and serum concentrations of the drug monitored closely. The manufacturer recommends that peak serum concentrations of streptomycin should not exceed 20-25 mcg/mL in patients with renal impairment.
Some clinicians recommend that adults with renal impairment receive an initial streptomycin loading dose of 15 mg/kg (approximately 1 g) of streptomycin. For subsequent therapy, these clinicians recommend that patients with creatinine clearances of 50-80 mL/minute receive 7.5 mg/kg once every 24 hours, those with creatinine clearances of 10-50 mL/minute receive 7.5
mg/kg once every 24-72 hours, and those with creatinine clearances less than 10 mL/minute receive 7.5 mg/kg once every 72-96 hours. In patients with renal failure undergoing hemodialysis, some clinicians recommend supplemental doses of 25% of the initial loading dose at the end of each dialysis period.
For the treatment of active tuberculosis in adults with renal impairment, the ATS, CDC, and IDSA recommend that usual doses be given at less frequent intervals since use of lower doses may reduce efficacy of the drug. These experts recommend that adults with renal impairment receive streptomycin in a dosage of 12-15 mg/kg daily given 2 or 3 times weekly. If the patient is receiving hemodialysis, the dose should be given after the procedure is finished. In addition, serum concentrations of the drug be should monitored to avoid toxicity.
Like other aminoglycosides, dosage of streptomycin should individualized taking into consideration the patient's pretreatment body weight, renal status, severity of the infection, and susceptibility of the causative organism.
Whenever possible, especially in patients with life-threatening infections, suspected toxicity or nonresponse to treatment, decreased or varying renal function, and/or when increased aminoglycoside clearance (e.g., patients with cystic fibrosis, burns) or prolonged therapy is likely, peak and trough serum concentrations of streptomycin should be monitored and dosage adjusted to maintain desired serum concentrations. (See Dosage and Administration: Dosage, in the Aminoglycosides General Statement 8:12.02.) A causal relationship between maintenance of certain peak or trough serum concentrations or other pharmacodynamic endpoints and clinical response or toxicity has not been established to date for streptomycin dosing regimens. However, suggested desirable peak and trough serum concentrations of streptomycin are 5-35 mcg/mL and less than 5-10 mcg/mL, respectively.
Peak serum streptomycin concentrations greater than 40-50 mcg/mL may be associated with toxicity; some clinicians state that persistent concentrations greater than 20 mcg/mL should be avoided. For the treatment of enterococcal endocarditis, the American Heart Association (AHA) and Infectious Diseases Society of America (IDSA) recommend that streptomycin dosage be adjusted to achieve 1-hour peak serum concentrations of 20-35 mcg/mL and trough concentrations less than 10 mcg/mL.
Although streptomycin dosage regimens that involve once-daily (single-daily) dosing are recommended for the treatment of tuberculosis and brucellosis, once-daily streptomycin regimens are not usually recommended for other indications and should not be used for the treatment of enterococcal or streptococcal endocarditis.
If IM streptomycin is used concomitantly with other anti-infectives for the treatment of moderate to severe infections caused by susceptible gram-negative or gram-positive bacteria, the usual adult dosage is 1-2 g daily given in divided doses every 6-12 hours. Streptomycin dosage generally should not exceed 2 g daily.
If IM streptomycin is used concomitantly with other anti-infectives for the treatment of moderate to severe infections caused by susceptible gram-negative or gram-positive bacteria, the usual dosage in children is 20-40 mg/kg daily given in divided doses every 6-12 hours. Particular care should be taken to avoid excessive dosage in children.
A streptomycin dosage of 7.5 mg/kg given IM every 12 hours has been used in neonates.
In patients with impaired renal function, doses and/or frequency of administration of streptomycin must be modified in response to serum concentrations of the drug and the degree of renal impairment. Because of the increased risk of ototoxicity and nephrotoxicity, streptomycin should be used with caution in patients with impaired renal function and serum concentrations of the drug monitored closely. The manufacturer recommends that peak serum concentrations of streptomycin should not exceed 20-25 mcg/mL in patients with renal impairment.
Some clinicians recommend that adults with renal impairment receive an initial streptomycin loading dose of 15 mg/kg (approximately 1 g) of streptomycin. For subsequent therapy, these clinicians recommend that patients with creatinine clearances of 50-80 mL/minute receive 7.5 mg/kg once every 24 hours, those with creatinine clearances of 10-50 mL/minute receive 7.5
mg/kg once every 24-72 hours, and those with creatinine clearances less than 10 mL/minute receive 7.5 mg/kg once every 72-96 hours. In patients with renal failure undergoing hemodialysis, some clinicians recommend supplemental doses of 25% of the initial loading dose at the end of each dialysis period.
For the treatment of active tuberculosis in adults with renal impairment, the ATS, CDC, and IDSA recommend that usual doses be given at less frequent intervals since use of lower doses may reduce efficacy of the drug. These experts recommend that adults with renal impairment receive streptomycin in a dosage of 12-15 mg/kg daily given 2 or 3 times weekly. If the patient is receiving hemodialysis, the dose should be given after the procedure is finished. In addition, serum concentrations of the drug be should monitored to avoid toxicity.
No enhanced Administration information available for this drug.
| DRUG LABEL | DOSING TYPE | DOSING INSTRUCTIONS |
|---|---|---|
| STREPTOMYCIN SULF 1 GM VIAL | Maintenance | Adults inject 500 mg by intramuscular route every 12 hours |
| DRUG LABEL | DOSING TYPE | DOSING INSTRUCTIONS |
|---|---|---|
| STREPTOMYCIN SULF 1 GM VIAL | Maintenance | Adults inject 500 mg by intramuscular route every 12 hours |
The following drug interaction information is available for STREPTOMYCIN SULFATE (streptomycin sulfate):
There are 2 contraindications.
These drug combinations generally should not be dispensed or administered to the same patient. A manufacturer label warning that indicates the contraindication warrants inclusion of a drug combination in this category, regardless of clinical evidence or lack of clinical evidence to support the contraindication.
| Drug Interaction | Drug Names |
|---|---|
| Live Typhoid Vaccine/Antimicrobials SEVERITY LEVEL: 1-Contraindicated Drug Combination: This drug combination is contraindicated and generally should not be dispensed or administered to the same patient. MECHANISM OF ACTION: The antimicrobial may be active against the organism in the live-vaccine. Antimicrobial therapy may prevent the vaccine organism from replicating enough to trigger an immune response.(1) CLINICAL EFFECTS: Vaccination may be ineffective. PREDISPOSING FACTORS: None determined. PATIENT MANAGEMENT: Do not give oral typhoid vaccine until 72 hours after the last dose of antimicrobial. If possible, to optimize vaccine effectiveness, do not start antibacterial drugs for 72 hours after the last dose of oral typhoid vaccine. A longer interval should be considered for long-acting antimicrobials, such as azithromycin.(3) DISCUSSION: Because antimicrobial therapy may prevent sufficient vaccine-organism replication to generate an immune response, the manufacturer of live-attenuated typhoid vaccine and the Centers for Disease Control (CDC) state that the vaccine should not be administered to patients receiving antimicrobial therapy.(1-3) |
VIVOTIF |
| Selected Nephrotoxic Agents/Bacitracin SEVERITY LEVEL: 1-Contraindicated Drug Combination: This drug combination is contraindicated and generally should not be dispensed or administered to the same patient. MECHANISM OF ACTION: Bacitracin may cause renal failure due to glomerular and tubular necrosis. Concurrent administration of other nephrotoxic agents may result in additive renal toxicity.(1-3) CLINICAL EFFECTS: Concurrent use of bacitracin with other potentially nephrotoxic agents may result in renal toxicity.(1-3) PREDISPOSING FACTORS: Dehydration and high-dose bacitracin may predispose to adverse renal effects.(1) PATIENT MANAGEMENT: Health Canada states that bacitracin is contraindicated in patients with renal impairment, including those taking other nephrotoxic drugs.(1) The Canadian and US manufacturers of bacitracin state that concomitant use of bacitracin with other potentially nephrotoxic agents should be avoided.(2,3) DISCUSSION: Renal impairment is a major toxicity of bacitracin. Cases of nephrotoxicity have been reported when bacitracin was used off-label.(1-3) |
BACITRACIN, BACITRACIN MICRONIZED, BACITRACIN ZINC |
There are 6 severe interactions.
These drug interactions can produce serious consequences in most patients. Actions required for severe interactions include, but are not limited to, discontinuing one or both agents, adjusting dosage, altering administration scheduling, and providing additional patient monitoring. Review the full interaction monograph for more information.
| Drug Interaction | Drug Names |
|---|---|
| Misc Antibiotics/Neuromuscular Blocking Agents SEVERITY LEVEL: 2-Severe Interaction: Action is required to reduce the risk of severe adverse interaction. MECHANISM OF ACTION: Aminoglycosides, bacitracin, clindamycin, lincomycin, and polymyxins may enhance the pharmacologic effects of neuromuscular blocking agents. CLINICAL EFFECTS: May see an increase in the pharmacologic effects of neuromuscular blocking agents, including prolonged respiratory depression and apnea. PREDISPOSING FACTORS: None determined. PATIENT MANAGEMENT: If it is necessary to administer these drugs concurrently, do so with extreme caution. Monitor neuromuscular function and adjust the dose of the neuromuscular blocking agent accordingly. DISCUSSION: Concomitant administration of aminoglycosides, bacitracin, clindamycin, lincomycin, and polymixins with neuromuscular blocking agents has been shown to produce synergism of the effects on skeletal muscles. Concurrent administration of these drugs has been associated with prolonged respiratory depression, respiratory paralysis, and fatal apnea. The interaction usually occurs when the antibiotic is given prior to or concurrently with the neuromuscular blocking drug, but it may also occur when given after administration. Any antibiotic dosage or route of administration may produce respiratory depression. |
ANECTINE, ATRACURIUM BESYLATE, BOTOX, BOTOX COSMETIC, CISATRACURIUM BESYLATE, DAXXIFY, DYSPORT, JEUVEAU, MYOBLOC, NIMBEX, QUELICIN, ROCURONIUM BROMIDE, SUCCINYLCHOLINE CHLORIDE, SUCCINYLCHOLINE CHLORIDE-NACL, VECURONIUM BROMIDE, VECURONIUM BROMIDE-WATER, XEOMIN |
| Anesthetics/Aminoglycosides SEVERITY LEVEL: 2-Severe Interaction: Action is required to reduce the risk of severe adverse interaction. MECHANISM OF ACTION: The neuromuscular blocking activity of aminoglycosides results from a decreased sensitivity at the postjunctional membrane and interfere with transmitter release.(1) These actions produce a synergistic effect with anesthetic agents that produce neuromuscular blockade.(2,3) Some anesthetics cause renal failure due to release of fluoride ion. Aminoglycosides cause nephrotoxicity when high doses are given.(4,5) CLINICAL EFFECTS: Increased neuromuscular blockade activity, profound sedation, respiratory depression, coma, and/or death. Circulatory collapse may also occur secondary to the neuromuscular blockade.(6-10) Decreased urinary output and increased BUN and serum creatinine may indicate renal impairment. PREDISPOSING FACTORS: Patients in respiratory distress, history of renal impairment and high doses of aminoglycosides and anesthetics. PATIENT MANAGEMENT: Monitor neuromuscular blockade with train-of-four stimulus. Monitor vital signs, and respiratory rate. Intravenous neostigmine (0.2 to 2.5 mg), calcium (1 G), and possibly sodium bicarbonate (dose not reported) may be beneficial in reversal of neuromuscular blockade and respiratory depression.(6-10) Supportive care and ventilation should be utilized until the neuromuscular blockade is resolved. Volume replacement may be necessary for circulatory collapse.(6-10) Monitor BUN, serum creatinine, and urinary output and adjust aminoglycoside and anesthetic doses according to renal function. DISCUSSION: Aminoglycosides including kanamycin(6,11), streptomycin(6,13), amikacin(13), gentamicin(7,13-15), neomycin, and tobramycin(13) have been documented to have neuromuscular blocking activity. There is no documentation with netilmicin and paromomycin, though it is assumed that they produce the same effects as the other members of this class. Neomycin has been shown to interact with cyclopropane(8,9), halothane(6), methoxyflurane(6), and nitrous oxide(6). Enflurane, ethylene, and isoflurane share similar properties to the previous inhalation anesthetics and would likely interact with neomycin. Kanamycin(6,11) and streptomycin (6,12) are known to interact with ether. Gentamicin has been reported to potentiate atracurium.(16) Therefore it is hypothesized that all aminoglycosides interact with the inhaled anesthetics. One study evaluating gentamicin and halothane in animals did not exhibit a decrease in muscle strength.(17) Aminoglycosides have been proven to be nephrotoxic at high doses. Anesthetics containing fluoride also produce renal dysfunction. Nephrotoxicity occurred more often when gentamicin or tobramycin were given with enflurane than when enflurane was given alone or in patients who received nitrous oxide and opioid anesthesia.(4) |
DESFLURANE, FORANE, ISOFLURANE, SUPRANE, TERRELL |
| Live BCG/Selected Antimycobacterials SEVERITY LEVEL: 2-Severe Interaction: Action is required to reduce the risk of severe adverse interaction. MECHANISM OF ACTION: Bacillus Calmette-Guerin (BCG) is a live, attenuated strain of Mycobacterium bovis (M.bovis) used to induce a granulomatous response in the treatment of localized bladder cancer and as a vaccine to prevent tuberculosis.(1-2) Co-treatment with antibacterial agents active against M.bovis may lead to an attenuation of the immune response associated with BCG administration.(1-2) CLINICAL EFFECTS: The effectiveness of chemotherapy may be impaired, or the vaccine may be ineffective. Agents linked to this monograph may have activity against M.bovis: amikacin, capreomycin, ciprofloxacin, clofazimine, cycloserine, ethambutol, ethionamide, gatifloxacin, isoniazid, kanamycin, levofloxacin, moxifloxacin, ofloxacin, rifabutin, rifampin, rifapentine, and streptomycin. PREDISPOSING FACTORS: None determined. PATIENT MANAGEMENT: Intravesical instillation of BCG should be postponed during treatment with antibacterials which may decrease effectiveness.(2) Administration of BCG vaccine to patients receiving antibiotic therapy should only be done under close medical supervision.(1) If a patient develops a systemic BCG infection due to intravesicular or vaccine administration, treatment with multiple antimycobacterial agents may be required. DISCUSSION: Because antibiotic therapy may prevent sufficient vaccine-organism replication to generate an immune response, the manufacturer of BCG vaccine states that administration of BCG vaccine to patients receiving antibiotic therapy should only be done under close medical supervision.(1) Pyrazinamide is not included in this interaction as BCG is not sensitive to pyrazinamide.(2) |
BCG (TICE STRAIN), BCG VACCINE (TICE STRAIN) |
| Fecal Microbiota Spores/Antibiotics SEVERITY LEVEL: 2-Severe Interaction: Action is required to reduce the risk of severe adverse interaction. MECHANISM OF ACTION: Fecal microbiota spores is a suspension of live bacterial spores, which may be compromised by concurrent use of antibiotics.(1) CLINICAL EFFECTS: Antibiotics may decrease the effectiveness of fecal microbiota spores.(1) PREDISPOSING FACTORS: None determined. PATIENT MANAGEMENT: Antibiotics should not be used concurrently with fecal microbiota spores. Antibacterial treatment should be completed for 2 to 4 days before initiating treatment with fecal microbiota spores.(1) DISCUSSION: Antibiotics may compromise the effectiveness of fecal microbiota spores. |
VOWST |
| Cyclosporine/Aminoglycosides SEVERITY LEVEL: 2-Severe Interaction: Action is required to reduce the risk of severe adverse interaction. MECHANISM OF ACTION: Cyclosporine and aminoglycosides can both cause nephrotoxicity. Concurrent administration may result in an additive or synergistic risk of nephrotoxicity.(1-3) CLINICAL EFFECTS: Concurrent use of cyclosporine with aminoglycosides may result in a higher risk of renal dysfunction, including structural kidney damage.(1-3) PREDISPOSING FACTORS: Factors predisposing to nephrotoxicity include pre-existing renal impairment, older age, higher doses or longer treatment duration of either drug, and dehydration.(1-3) PATIENT MANAGEMENT: Avoid the concurrent use of cyclosporine and aminoglycosides whenever possible.(2,3) If concurrent use cannot be avoided, it should be undertaken with great caution. Minimize the cyclosporine dose and monitor renal function carefully. Frequent dose adjustment may be indicated. If renal function deteriorates, the aminoglycoside may need to be decreased or discontinued.(1-4) DISCUSSION: Coadministration of cyclosporine with other drugs that may impair renal function, like aminoglycosides, may cause additive or synergistic impairment of renal function. A meta-analysis of 30 studies that evaluated the correlation and risk factors between cyclosporine and kidney injury in allogeneic hematopoietic stem cell transplant (allo-HSCT) patients included 7 studies that examined the role of the combination with other drugs in the development of nephrotoxicity. Coadministration of aminoglycosides and amphotericin B were independent risk factors for acute or chronic kidney diseases related to cyclosporine in allo-HSCT patients.(5) |
CYCLOSPORINE, CYCLOSPORINE MODIFIED, GENGRAF, NEORAL, SANDIMMUNE |
| Selected Nephrotoxic Agents/Polymyxin B SEVERITY LEVEL: 2-Severe Interaction: Action is required to reduce the risk of severe adverse interaction. MECHANISM OF ACTION: Polymyxin B can cause nephrotoxicity with a slight degree of tubular damage. Concurrent administration of other nephrotoxic agents may result in an increased risk of nephrotoxicity.(1) CLINICAL EFFECTS: Concurrent use of polymyxin B with other nephrotoxic agents may result in additive nephrotoxic effects. Polymyxin B nephrotoxicity is characterized by albuminuria, cellular casts, azotemia, diminished urine output, elevated BUN and rising blood levels usually after about 4 days of therapy.(1,2) PREDISPOSING FACTORS: Factors predisposing to nephrotoxicity include higher cumulative doses and longer duration of therapy of polymyxin B and exposure to multiple nephrotoxins.(2) PATIENT MANAGEMENT: Concurrent or sequential use of potentially nephrotoxic agents with polymyxin B should be avoided. If concurrent use is necessary, it should be undertaken with great caution. Check renal function at baseline and monitor renal function and polymyxin B blood levels frequently during therapy.(1) DISCUSSION: Polymyxin B is associated with high rates of nephrotoxicity. Concurrent use with other nephrotoxins may increase the risk of nephrotoxicity. |
POLYMYXIN B SULFATE |
There are 2 moderate interactions.
The clinician should assess the patient’s characteristics and take action as needed. Actions required for moderate interactions include, but are not limited to, discontinuing one or both agents, adjusting dosage, altering administration.
| Drug Interaction | Drug Names |
|---|---|
| Aminoglycosides/Loop Diuretics SEVERITY LEVEL: 3-Moderate Interaction: Assess the risk to the patient and take action as needed. MECHANISM OF ACTION: The coadministration of aminoglycosides and loop diuretics may result in additive or synergistic ototoxicity and/or nephrotoxicity. CLINICAL EFFECTS: The combination of an aminoglycoside and a loop diuretic may increase risk for serious nephrotoxicity or ototoxicity.(1,2) Vestibular or auditory ototoxicity may be permanent.(1,3) PREDISPOSING FACTORS: Preexisting renal impairment, extended duration of aminoglycoside therapy, greater than one aminoglycoside dose per day, rapid injection or high doses of loop diuretics, concomitant use of additional nephrotoxic agents such as iodinated contrast media or vancomycin, or sepsis appear to increase the risk for nephrotoxicity and ototoxicity.(1-6). Patients carrying certain variants in the MT-RNR1 gene (m.1555A>G, m.1095T>C, and m.1494C>T) are at increased risk of developing ototoxicity. An additional risk factor includes patients with a maternal relative known to have a clinically relevant MT-RNR1 variant. The risk of ototoxicity can occur at standard recommended doses of aminoglycosides.(7) PATIENT MANAGEMENT: Administer aminoglycoside dosage every 24 to > 48 hours based upon renal function and continue therapy for less than 4 to 7 days, whenever possible.(4,5) The recommended maximal infusion rate for high dose furosemide therapy is 4 mg/minute.(2) When concurrent therapy is necessary monitor renal, hearing, and vestibular function. Signs of vestibular dysfunction include loss of balance and/or the visual sensation that stationary objects are moving (oscillopsia). In hospitalized or bedbound patients these symptoms may not be noticed or may be ascribed to other etiologies.(3) DISCUSSION: Several studies and case reports have documented altered aminoglycoside levels, nephrotoxicity, and ototoxicity with concurrent therapy.(8-14) Otic aminoglycosides are included in this interaction because high aminoglycoside concentrations in the ear have been associated with an increased risk for hearing loss. |
BUMETANIDE, EDECRIN, ETHACRYNATE SODIUM, ETHACRYNIC ACID, FUROSCIX, FUROSEMIDE, FUROSEMIDE-0.9% NACL, LASIX, SOAANZ, TORSEMIDE |
| Selected Nephrotoxic Agents/Cisplatin SEVERITY LEVEL: 3-Moderate Interaction: Assess the risk to the patient and take action as needed. MECHANISM OF ACTION: The nephrotoxic effects of aminoglycosides or non-steroidal anti-inflammatory drugs (NSAIDs) may be additive to those of cisplatin. CLINICAL EFFECTS: The concurrent administration of amikacin, gentamicin, tobramycin, or NSAIDs with cisplatin may result in additive nephrotoxic effects.(1,2,5,6) PREDISPOSING FACTORS: Pre-existing renal insufficiency, advanced age, dehydration may increase the risk of nephrotoxicity.(1,5,6) PATIENT MANAGEMENT: The US labeling for aminoglycosides and cisplatin states that the concurrent use of aminoglycosides and cisplatin should be avoided.(1,3,4,6) Inform patients that concurrent cisplatin and aminoglycosides or NSAIDs can cause nephrotoxicity and that renal function and electrolyte monitoring during treatment is necessary.(2) DISCUSSION: The US manufacturers of amikacin, gentamicin and tobramycin state that since the nephrotoxic effects of these medications may be additive, avoid concurrent or sequential use of other neurotoxic and/or nephrotoxic agents including cisplatin.(1,3,6) |
CISPLATIN, KEMOPLAT |
The following contraindication information is available for STREPTOMYCIN SULFATE (streptomycin sulfate):
Drug contraindication overview.
No enhanced Contraindications information available for this drug.
No enhanced Contraindications information available for this drug.
There are 1 contraindications.
Absolute contraindication.
| Contraindication List |
|---|
| Mt-RNr1 increased risk of aminoglycoside-induced hearing loss |
There are 10 severe contraindications.
Adequate patient monitoring is recommended for safer drug use.
| Severe List |
|---|
| Clostridioides difficile infection |
| Dehydration |
| Disorder of the vestibulocochlear nerve |
| Hypocalcemia |
| Infant botulism |
| Kidney disease with reduction in glomerular filtration rate (GFr) |
| Myasthenia gravis |
| Pregnancy |
| Tinnitus |
| Vertigo |
There are 1 moderate contraindications.
Clinically significant contraindication, where the condition can be managed or treated before the drug may be given safely.
| Moderate List |
|---|
| Parkinsonism |
The following adverse reaction information is available for STREPTOMYCIN SULFATE (streptomycin sulfate):
Adverse reaction overview.
No enhanced Common Adverse Effects information available for this drug.
No enhanced Common Adverse Effects information available for this drug.
There are 13 severe adverse reactions.
| More Frequent | Less Frequent |
|---|---|
|
Auditory neurotoxicity CNS toxicity Kidney disease with reduction in glomerular filtration rate (GFr) Nephrotoxicity Ototoxicity Peripheral neuropathy |
Allergic dermatitis Angioedema Erythema Optic neuritis Pruritus of skin Skin rash |
| Rare/Very Rare |
|---|
|
Neuromuscular blockade |
There are 0 less severe adverse reactions.
The following precautions are available for STREPTOMYCIN SULFATE (streptomycin sulfate):
No enhanced Pediatric Use information available for this drug.
Contraindicated
Severe Precaution
Management or Monitoring Precaution
Contraindicated
| None |
Severe Precaution
| None |
Management or Monitoring Precaution
| None |
No enhanced Pregnancy information available for this drug.
No enhanced Lactation information available for this drug.
No enhanced Geriatric Use information available for this drug.
The following prioritized warning is available for STREPTOMYCIN SULFATE (streptomycin sulfate):
WARNING: This medication can sometimes cause serious nerve damage, possibly resulting in permanent hearing loss and balance problems. The risk is higher if you have kidney disease, if you are receiving high doses of this medication, if you use this drug for a long time, if you are an older adult (older than 60 years), or if you develop a severe loss of body water (become dehydrated). To reduce the risk of dehydration, drink plenty of fluids while using this medication unless your doctor directs you otherwise.
Before starting streptomycin, tell your doctor if you already have kidney or hearing problems. Tell your doctor right away if you notice ringing/roaring in the ears, headache, hearing loss, balance problems, unusual drowsiness, dizziness, vision changes, or numbness/tingling of the skin. Your doctor will monitor your progress to reduce the risk of these side effects and may test your hearing, kidneys, and streptomycin blood level.
This medication may be stopped if you develop kidney problems or hearing problems. If possible, you should avoid using any other medications that may harm the kidneys or nerves while using streptomycin (such as cidofovir, cisplatin, cyclosporine, other aminoglycoside antibiotics such as gentamicin/tobramycin, among others). Before having surgery, tell your doctor or dentist that you are using this medication. This drug may affect many of the drugs used during surgery and may increase your risk of side effects.
WARNING: This medication can sometimes cause serious nerve damage, possibly resulting in permanent hearing loss and balance problems. The risk is higher if you have kidney disease, if you are receiving high doses of this medication, if you use this drug for a long time, if you are an older adult (older than 60 years), or if you develop a severe loss of body water (become dehydrated). To reduce the risk of dehydration, drink plenty of fluids while using this medication unless your doctor directs you otherwise.
Before starting streptomycin, tell your doctor if you already have kidney or hearing problems. Tell your doctor right away if you notice ringing/roaring in the ears, headache, hearing loss, balance problems, unusual drowsiness, dizziness, vision changes, or numbness/tingling of the skin. Your doctor will monitor your progress to reduce the risk of these side effects and may test your hearing, kidneys, and streptomycin blood level.
This medication may be stopped if you develop kidney problems or hearing problems. If possible, you should avoid using any other medications that may harm the kidneys or nerves while using streptomycin (such as cidofovir, cisplatin, cyclosporine, other aminoglycoside antibiotics such as gentamicin/tobramycin, among others). Before having surgery, tell your doctor or dentist that you are using this medication. This drug may affect many of the drugs used during surgery and may increase your risk of side effects.
The following icd codes are available for STREPTOMYCIN SULFATE (streptomycin sulfate)'s list of indications:
| Active tuberculosis | |
| A15 | Respiratory tuberculosis |
| A15.0 | Tuberculosis of lung |
| A15.4 | Tuberculosis of intrathoracic lymph nodes |
| A15.5 | Tuberculosis of larynx, trachea and bronchus |
| A15.6 | Tuberculous pleurisy |
| A15.7 | Primary respiratory tuberculosis |
| A15.8 | Other respiratory tuberculosis |
| A15.9 | Respiratory tuberculosis unspecified |
| A17 | Tuberculosis of nervous system |
| A17.0 | Tuberculous meningitis |
| A17.1 | Meningeal tuberculoma |
| A17.8 | Other tuberculosis of nervous system |
| A17.81 | Tuberculoma of brain and spinal cord |
| A17.82 | Tuberculous meningoencephalitis |
| A17.83 | Tuberculous neuritis |
| A17.89 | Other tuberculosis of nervous system |
| A17.9 | Tuberculosis of nervous system, unspecified |
| A18 | Tuberculosis of other organs |
| A18.0 | Tuberculosis of bones and joints |
| A18.01 | Tuberculosis of spine |
| A18.02 | Tuberculous arthritis of other joints |
| A18.03 | Tuberculosis of other bones |
| A18.09 | Other musculoskeletal tuberculosis |
| A18.1 | Tuberculosis of genitourinary system |
| A18.10 | Tuberculosis of genitourinary system, unspecified |
| A18.11 | Tuberculosis of kidney and ureter |
| A18.12 | Tuberculosis of bladder |
| A18.13 | Tuberculosis of other urinary organs |
| A18.14 | Tuberculosis of prostate |
| A18.15 | Tuberculosis of other male genital organs |
| A18.16 | Tuberculosis of cervix |
| A18.17 | Tuberculous female pelvic inflammatory disease |
| A18.18 | Tuberculosis of other female genital organs |
| A18.2 | Tuberculous peripheral lymphadenopathy |
| A18.3 | Tuberculosis of intestines, peritoneum and mesenteric glands |
| A18.31 | Tuberculous peritonitis |
| A18.32 | Tuberculous enteritis |
| A18.39 | Retroperitoneal tuberculosis |
| A18.4 | Tuberculosis of skin and subcutaneous tissue |
| A18.5 | Tuberculosis of eye |
| A18.50 | Tuberculosis of eye, unspecified |
| A18.51 | Tuberculous episcleritis |
| A18.52 | Tuberculous keratitis |
| A18.53 | Tuberculous chorioretinitis |
| A18.54 | Tuberculous iridocyclitis |
| A18.59 | Other tuberculosis of eye |
| A18.6 | Tuberculosis of (inner) (middle) ear |
| A18.7 | Tuberculosis of adrenal glands |
| A18.8 | Tuberculosis of other specified organs |
| A18.81 | Tuberculosis of thyroid gland |
| A18.82 | Tuberculosis of other endocrine glands |
| A18.83 | Tuberculosis of digestive tract organs, not elsewhere classified |
| A18.84 | Tuberculosis of heart |
| A18.85 | Tuberculosis of spleen |
| A18.89 | Tuberculosis of other sites |
| A19 | Miliary tuberculosis |
| A19.0 | Acute miliary tuberculosis of a single specified site |
| A19.1 | Acute miliary tuberculosis of multiple sites |
| A19.2 | Acute miliary tuberculosis, unspecified |
| A19.8 | Other miliary tuberculosis |
| A19.9 | Miliary tuberculosis, unspecified |
| O98.0 | Tuberculosis complicating pregnancy, childbirth and the puerperium |
| O98.01 | Tuberculosis complicating pregnancy |
| O98.011 | Tuberculosis complicating pregnancy, first trimester |
| O98.012 | Tuberculosis complicating pregnancy, second trimester |
| O98.013 | Tuberculosis complicating pregnancy, third trimester |
| O98.019 | Tuberculosis complicating pregnancy, unspecified trimester |
| O98.02 | Tuberculosis complicating childbirth |
| O98.03 | Tuberculosis complicating the puerperium |
| P37.0 | Congenital tuberculosis |
| Aerobic gram-negative bacteremia | |
| A41.3 | Sepsis due to hemophilus influenzae |
| A41.5 | Sepsis due to other gram-negative organisms |
| A41.50 | Gram-negative sepsis, unspecified |
| A41.51 | Sepsis due to escherichia coli [e. coli] |
| A41.52 | Sepsis due to pseudomonas |
| A41.53 | Sepsis due to serratia |
| A41.54 | Sepsis due to acinetobacter baumannii |
| A41.59 | Other gram-negative sepsis |
| P36.4 | Sepsis of newborn due to escherichia coli |
| Bacterial urinary tract infection | |
| N30.0 | Acute cystitis |
| N30.00 | Acute cystitis without hematuria |
| N30.01 | Acute cystitis with hematuria |
| N30.9 | Cystitis, unspecified |
| N30.90 | Cystitis, unspecified without hematuria |
| N30.91 | Cystitis, unspecified with hematuria |
| N39.0 | Urinary tract infection, site not specified |
| O23.0 | Infections of kidney in pregnancy |
| O23.00 | Infections of kidney in pregnancy, unspecified trimester |
| O23.01 | Infections of kidney in pregnancy, first trimester |
| O23.02 | Infections of kidney in pregnancy, second trimester |
| O23.03 | Infections of kidney in pregnancy, third trimester |
| O23.1 | Infections of bladder in pregnancy |
| O23.10 | Infections of bladder in pregnancy, unspecified trimester |
| O23.11 | Infections of bladder in pregnancy, first trimester |
| O23.12 | Infections of bladder in pregnancy, second trimester |
| O23.13 | Infections of bladder in pregnancy, third trimester |
| O23.2 | Infections of urethra in pregnancy |
| O23.20 | Infections of urethra in pregnancy, unspecified trimester |
| O23.21 | Infections of urethra in pregnancy, first trimester |
| O23.22 | Infections of urethra in pregnancy, second trimester |
| O23.23 | Infections of urethra in pregnancy, third trimester |
| O23.3 | Infections of other parts of urinary tract in pregnancy |
| O23.30 | Infections of other parts of urinary tract in pregnancy, unspecified trimester |
| O23.31 | Infections of other parts of urinary tract in pregnancy, first trimester |
| O23.32 | Infections of other parts of urinary tract in pregnancy, second trimester |
| O23.33 | Infections of other parts of urinary tract in pregnancy, third trimester |
| O23.4 | Unspecified infection of urinary tract in pregnancy |
| O23.40 | Unspecified infection of urinary tract in pregnancy, unspecified trimester |
| O23.41 | Unspecified infection of urinary tract in pregnancy, first trimester |
| O23.42 | Unspecified infection of urinary tract in pregnancy, second trimester |
| O23.43 | Unspecified infection of urinary tract in pregnancy, third trimester |
| O23.90 | Unspecified genitourinary tract infection in pregnancy, unspecified trimester |
| O23.91 | Unspecified genitourinary tract infection in pregnancy, first trimester |
| O23.92 | Unspecified genitourinary tract infection in pregnancy, second trimester |
| O23.93 | Unspecified genitourinary tract infection in pregnancy, third trimester |
| P39.3 | Neonatal urinary tract infection |
| T83 | Complications of genitourinary prosthetic devices, implants and grafts |
| T83.5 | Infection and inflammatory reaction due to prosthetic device, implant and graft in urinary system |
| T83.51 | Infection and inflammatory reaction due to urinary catheter |
| T83.59 | Infection and inflammatory reaction due to prosthetic device, implant and graft in urinary system |
| T83.6 | Infection and inflammatory reaction due to prosthetic device, implant and graft in genital tract |
| Brucellosis | |
| A23 | Brucellosis |
| A23.0 | Brucellosis due to brucella melitensis |
| A23.1 | Brucellosis due to brucella abortus |
| A23.2 | Brucellosis due to brucella suis |
| A23.3 | Brucellosis due to brucella canis |
| A23.8 | Other brucellosis |
| A23.9 | Brucellosis, unspecified |
| E. coli urinary tract infection | |
| B96.2 | Escherichia coli [e. coli ] as the cause of diseases classified elsewhere |
| B96.20 | Unspecified escherichia coli [e. coli] as the cause of diseases classified elsewhere |
| B96.29 | Other escherichia coli [e. coli] as the cause of diseases classified elsewhere |
| N30.0 | Acute cystitis |
| N30.00 | Acute cystitis without hematuria |
| N30.01 | Acute cystitis with hematuria |
| N30.9 | Cystitis, unspecified |
| N30.90 | Cystitis, unspecified without hematuria |
| N30.91 | Cystitis, unspecified with hematuria |
| N39.0 | Urinary tract infection, site not specified |
| O23.0 | Infections of kidney in pregnancy |
| O23.00 | Infections of kidney in pregnancy, unspecified trimester |
| O23.01 | Infections of kidney in pregnancy, first trimester |
| O23.02 | Infections of kidney in pregnancy, second trimester |
| O23.03 | Infections of kidney in pregnancy, third trimester |
| O23.1 | Infections of bladder in pregnancy |
| O23.10 | Infections of bladder in pregnancy, unspecified trimester |
| O23.11 | Infections of bladder in pregnancy, first trimester |
| O23.12 | Infections of bladder in pregnancy, second trimester |
| O23.13 | Infections of bladder in pregnancy, third trimester |
| O23.2 | Infections of urethra in pregnancy |
| O23.20 | Infections of urethra in pregnancy, unspecified trimester |
| O23.21 | Infections of urethra in pregnancy, first trimester |
| O23.22 | Infections of urethra in pregnancy, second trimester |
| O23.23 | Infections of urethra in pregnancy, third trimester |
| O23.3 | Infections of other parts of urinary tract in pregnancy |
| O23.30 | Infections of other parts of urinary tract in pregnancy, unspecified trimester |
| O23.31 | Infections of other parts of urinary tract in pregnancy, first trimester |
| O23.32 | Infections of other parts of urinary tract in pregnancy, second trimester |
| O23.33 | Infections of other parts of urinary tract in pregnancy, third trimester |
| O23.4 | Unspecified infection of urinary tract in pregnancy |
| O23.40 | Unspecified infection of urinary tract in pregnancy, unspecified trimester |
| O23.41 | Unspecified infection of urinary tract in pregnancy, first trimester |
| O23.42 | Unspecified infection of urinary tract in pregnancy, second trimester |
| O23.43 | Unspecified infection of urinary tract in pregnancy, third trimester |
| O23.9 | Unspecified genitourinary tract infection in pregnancy |
| O23.90 | Unspecified genitourinary tract infection in pregnancy, unspecified trimester |
| O23.91 | Unspecified genitourinary tract infection in pregnancy, first trimester |
| O23.92 | Unspecified genitourinary tract infection in pregnancy, second trimester |
| O23.93 | Unspecified genitourinary tract infection in pregnancy, third trimester |
| Enterobacter cloacae urinary tract infection | |
| B96.89 | Other specified bacterial agents as the cause of diseases classified elsewhere |
| N30.0 | Acute cystitis |
| N30.00 | Acute cystitis without hematuria |
| N30.01 | Acute cystitis with hematuria |
| N30.9 | Cystitis, unspecified |
| N30.90 | Cystitis, unspecified without hematuria |
| N30.91 | Cystitis, unspecified with hematuria |
| N39.0 | Urinary tract infection, site not specified |
| O23.0 | Infections of kidney in pregnancy |
| O23.00 | Infections of kidney in pregnancy, unspecified trimester |
| O23.01 | Infections of kidney in pregnancy, first trimester |
| O23.02 | Infections of kidney in pregnancy, second trimester |
| O23.03 | Infections of kidney in pregnancy, third trimester |
| O23.1 | Infections of bladder in pregnancy |
| O23.10 | Infections of bladder in pregnancy, unspecified trimester |
| O23.11 | Infections of bladder in pregnancy, first trimester |
| O23.12 | Infections of bladder in pregnancy, second trimester |
| O23.13 | Infections of bladder in pregnancy, third trimester |
| O23.2 | Infections of urethra in pregnancy |
| O23.20 | Infections of urethra in pregnancy, unspecified trimester |
| O23.21 | Infections of urethra in pregnancy, first trimester |
| O23.22 | Infections of urethra in pregnancy, second trimester |
| O23.23 | Infections of urethra in pregnancy, third trimester |
| O23.3 | Infections of other parts of urinary tract in pregnancy |
| O23.30 | Infections of other parts of urinary tract in pregnancy, unspecified trimester |
| O23.31 | Infections of other parts of urinary tract in pregnancy, first trimester |
| O23.32 | Infections of other parts of urinary tract in pregnancy, second trimester |
| O23.33 | Infections of other parts of urinary tract in pregnancy, third trimester |
| O23.4 | Unspecified infection of urinary tract in pregnancy |
| O23.40 | Unspecified infection of urinary tract in pregnancy, unspecified trimester |
| O23.41 | Unspecified infection of urinary tract in pregnancy, first trimester |
| O23.42 | Unspecified infection of urinary tract in pregnancy, second trimester |
| O23.43 | Unspecified infection of urinary tract in pregnancy, third trimester |
| O23.9 | Unspecified genitourinary tract infection in pregnancy |
| O23.90 | Unspecified genitourinary tract infection in pregnancy, unspecified trimester |
| O23.91 | Unspecified genitourinary tract infection in pregnancy, first trimester |
| O23.92 | Unspecified genitourinary tract infection in pregnancy, second trimester |
| O23.93 | Unspecified genitourinary tract infection in pregnancy, third trimester |
| Enterococcus urinary tract infection | |
| B95.2 | Enterococcus as the cause of diseases classified elsewhere |
| N30.0 | Acute cystitis |
| N30.00 | Acute cystitis without hematuria |
| N30.01 | Acute cystitis with hematuria |
| N30.9 | Cystitis, unspecified |
| N30.90 | Cystitis, unspecified without hematuria |
| N30.91 | Cystitis, unspecified with hematuria |
| N39.0 | Urinary tract infection, site not specified |
| O23.0 | Infections of kidney in pregnancy |
| O23.00 | Infections of kidney in pregnancy, unspecified trimester |
| O23.01 | Infections of kidney in pregnancy, first trimester |
| O23.02 | Infections of kidney in pregnancy, second trimester |
| O23.03 | Infections of kidney in pregnancy, third trimester |
| O23.1 | Infections of bladder in pregnancy |
| O23.10 | Infections of bladder in pregnancy, unspecified trimester |
| O23.11 | Infections of bladder in pregnancy, first trimester |
| O23.12 | Infections of bladder in pregnancy, second trimester |
| O23.13 | Infections of bladder in pregnancy, third trimester |
| O23.2 | Infections of urethra in pregnancy |
| O23.20 | Infections of urethra in pregnancy, unspecified trimester |
| O23.21 | Infections of urethra in pregnancy, first trimester |
| O23.22 | Infections of urethra in pregnancy, second trimester |
| O23.23 | Infections of urethra in pregnancy, third trimester |
| O23.3 | Infections of other parts of urinary tract in pregnancy |
| O23.30 | Infections of other parts of urinary tract in pregnancy, unspecified trimester |
| O23.31 | Infections of other parts of urinary tract in pregnancy, first trimester |
| O23.32 | Infections of other parts of urinary tract in pregnancy, second trimester |
| O23.33 | Infections of other parts of urinary tract in pregnancy, third trimester |
| O23.4 | Unspecified infection of urinary tract in pregnancy |
| O23.40 | Unspecified infection of urinary tract in pregnancy, unspecified trimester |
| O23.41 | Unspecified infection of urinary tract in pregnancy, first trimester |
| O23.42 | Unspecified infection of urinary tract in pregnancy, second trimester |
| O23.43 | Unspecified infection of urinary tract in pregnancy, third trimester |
| O23.9 | Unspecified genitourinary tract infection in pregnancy |
| O23.90 | Unspecified genitourinary tract infection in pregnancy, unspecified trimester |
| O23.91 | Unspecified genitourinary tract infection in pregnancy, first trimester |
| O23.92 | Unspecified genitourinary tract infection in pregnancy, second trimester |
| O23.93 | Unspecified genitourinary tract infection in pregnancy, third trimester |
| Granuloma inguinale | |
| A58 | Granuloma inguinale |
| H. influenzae meningitis | |
| G00.0 | Hemophilus meningitis |
| Haemophilus influenzae pneumonia | |
| J14 | Pneumonia due to hemophilus influenzae |
| Klebsiella urinary tract infection | |
| B96.1 | Klebsiella pneumoniae [k. pneumoniae] as the cause of diseases classified elsewhere |
| N30.0 | Acute cystitis |
| N30.00 | Acute cystitis without hematuria |
| N30.01 | Acute cystitis with hematuria |
| N30.9 | Cystitis, unspecified |
| N30.90 | Cystitis, unspecified without hematuria |
| N30.91 | Cystitis, unspecified with hematuria |
| N39.0 | Urinary tract infection, site not specified |
| O23.0 | Infections of kidney in pregnancy |
| O23.00 | Infections of kidney in pregnancy, unspecified trimester |
| O23.01 | Infections of kidney in pregnancy, first trimester |
| O23.02 | Infections of kidney in pregnancy, second trimester |
| O23.03 | Infections of kidney in pregnancy, third trimester |
| O23.1 | Infections of bladder in pregnancy |
| O23.10 | Infections of bladder in pregnancy, unspecified trimester |
| O23.11 | Infections of bladder in pregnancy, first trimester |
| O23.12 | Infections of bladder in pregnancy, second trimester |
| O23.13 | Infections of bladder in pregnancy, third trimester |
| O23.2 | Infections of urethra in pregnancy |
| O23.20 | Infections of urethra in pregnancy, unspecified trimester |
| O23.21 | Infections of urethra in pregnancy, first trimester |
| O23.22 | Infections of urethra in pregnancy, second trimester |
| O23.23 | Infections of urethra in pregnancy, third trimester |
| O23.3 | Infections of other parts of urinary tract in pregnancy |
| O23.30 | Infections of other parts of urinary tract in pregnancy, unspecified trimester |
| O23.31 | Infections of other parts of urinary tract in pregnancy, first trimester |
| O23.32 | Infections of other parts of urinary tract in pregnancy, second trimester |
| O23.33 | Infections of other parts of urinary tract in pregnancy, third trimester |
| O23.4 | Unspecified infection of urinary tract in pregnancy |
| O23.40 | Unspecified infection of urinary tract in pregnancy, unspecified trimester |
| O23.41 | Unspecified infection of urinary tract in pregnancy, first trimester |
| O23.42 | Unspecified infection of urinary tract in pregnancy, second trimester |
| O23.43 | Unspecified infection of urinary tract in pregnancy, third trimester |
| O23.9 | Unspecified genitourinary tract infection in pregnancy |
| O23.90 | Unspecified genitourinary tract infection in pregnancy, unspecified trimester |
| O23.91 | Unspecified genitourinary tract infection in pregnancy, first trimester |
| O23.92 | Unspecified genitourinary tract infection in pregnancy, second trimester |
| O23.93 | Unspecified genitourinary tract infection in pregnancy, third trimester |
| Plague | |
| A20 | Plague |
| A20.0 | Bubonic plague |
| A20.1 | Cellulocutaneous plague |
| A20.2 | Pneumonic plague |
| A20.3 | Plague meningitis |
| A20.7 | Septicemic plague |
| A20.8 | Other forms of plague |
| A20.9 | Plague, unspecified |
| Proteus urinary tract infection | |
| B96.4 | Proteus (mirabilis) (morganii) as the cause of diseases classified elsewhere |
| N30.0 | Acute cystitis |
| N30.00 | Acute cystitis without hematuria |
| N30.01 | Acute cystitis with hematuria |
| N30.9 | Cystitis, unspecified |
| N30.90 | Cystitis, unspecified without hematuria |
| N30.91 | Cystitis, unspecified with hematuria |
| N39.0 | Urinary tract infection, site not specified |
| O23.0 | Infections of kidney in pregnancy |
| O23.00 | Infections of kidney in pregnancy, unspecified trimester |
| O23.01 | Infections of kidney in pregnancy, first trimester |
| O23.02 | Infections of kidney in pregnancy, second trimester |
| O23.03 | Infections of kidney in pregnancy, third trimester |
| O23.1 | Infections of bladder in pregnancy |
| O23.10 | Infections of bladder in pregnancy, unspecified trimester |
| O23.11 | Infections of bladder in pregnancy, first trimester |
| O23.12 | Infections of bladder in pregnancy, second trimester |
| O23.13 | Infections of bladder in pregnancy, third trimester |
| O23.2 | Infections of urethra in pregnancy |
| O23.20 | Infections of urethra in pregnancy, unspecified trimester |
| O23.21 | Infections of urethra in pregnancy, first trimester |
| O23.22 | Infections of urethra in pregnancy, second trimester |
| O23.23 | Infections of urethra in pregnancy, third trimester |
| O23.3 | Infections of other parts of urinary tract in pregnancy |
| O23.30 | Infections of other parts of urinary tract in pregnancy, unspecified trimester |
| O23.31 | Infections of other parts of urinary tract in pregnancy, first trimester |
| O23.32 | Infections of other parts of urinary tract in pregnancy, second trimester |
| O23.33 | Infections of other parts of urinary tract in pregnancy, third trimester |
| O23.4 | Unspecified infection of urinary tract in pregnancy |
| O23.40 | Unspecified infection of urinary tract in pregnancy, unspecified trimester |
| O23.41 | Unspecified infection of urinary tract in pregnancy, first trimester |
| O23.42 | Unspecified infection of urinary tract in pregnancy, second trimester |
| O23.43 | Unspecified infection of urinary tract in pregnancy, third trimester |
| O23.9 | Unspecified genitourinary tract infection in pregnancy |
| O23.90 | Unspecified genitourinary tract infection in pregnancy, unspecified trimester |
| O23.91 | Unspecified genitourinary tract infection in pregnancy, first trimester |
| O23.92 | Unspecified genitourinary tract infection in pregnancy, second trimester |
| O23.93 | Unspecified genitourinary tract infection in pregnancy, third trimester |
| Pulmonary tuberculosis | |
| A15 | Respiratory tuberculosis |
| A15.0 | Tuberculosis of lung |
| A15.7 | Primary respiratory tuberculosis |
| A15.8 | Other respiratory tuberculosis |
| Synergy for enterococcal endocarditis | |
| B95.2 | Enterococcus as the cause of diseases classified elsewhere |
| I33.0 | Acute and subacute infective endocarditis |
| Synergy for enterococcal infection | |
| A41.81 | Sepsis due to enterococcus |
| B95.2 | Enterococcus as the cause of diseases classified elsewhere |
| Synergy for streptococcal endocarditis | |
| B95.0 | Streptococcus, group a, as the cause of diseases classified elsewhere |
| B95.1 | Streptococcus, group b, as the cause of diseases classified elsewhere |
| B95.3 | Streptococcus pneumoniae as the cause of diseases classified elsewhere |
| B95.4 | Other streptococcus as the cause of diseases classified elsewhere |
| B95.5 | Unspecified streptococcus as the cause of diseases classified elsewhere |
| I33.0 | Acute and subacute infective endocarditis |
| Tularemia | |
| A21 | Tularemia |
| A21.0 | Ulceroglandular tularemia |
| A21.1 | Oculoglandular tularemia |
| A21.2 | Pulmonary tularemia |
| A21.3 | Gastrointestinal tularemia |
| A21.7 | Generalized tularemia |
| A21.8 | Other forms of tularemia |
| A21.9 | Tularemia, unspecified |
Formulary Reference Tool