Streptomycin
| Evidence Level: L4 | Predicted Indications: 10 |
Table of Contents
Streptomycin: From Tuberculosis and Other Bacterial Infections to Conjunctivitis
One-Sentence Summary
Streptomycin is an aminoglycoside antibiotic originally used for pulmonary tuberculosis and several other bacterial infections, such as plague, tularemia and brucellosis. The TxGNN model predicts it may be effective for conjunctivitis, but there are 0 registered clinical trials and only a handful of relevant publications, mostly old case reports and reviews, so the evidence is weak.
Quick Overview
| Item | Content |
|---|---|
| Original Indication | Pulmonary tuberculosis, plague, tularemia, brucellosis and other bacterial infections (the Singapore licence has no indication text on file) |
| Predicted New Indication | Conjunctivitis |
| TxGNN Prediction Score | 99.87% |
| Evidence Level | L4 |
| Singapore Market Status | ✓ Marketed |
| Number of Registrations | 1 |
| Recommended Decision | Hold |
Why is This Prediction Reasonable?
Detailed mechanism of action data is not available in the data compiled for this report. Streptomycin is generally understood to be a bactericidal aminoglycoside that inhibits the bacterial 30S ribosomal subunit. Its efficacy in its original infectious indications is established.
The link to conjunctivitis is indirect. Some of streptomycin's original target infections can involve the eye. Tularemia can cause Parinaud oculoglandular syndrome, and brucellosis can cause keratoconjunctivitis. Old reports also describe tuberculous conjunctivitis treated with streptomycin. These cases show a pathogen-specific connection, not evidence for common bacterial conjunctivitis.
There are also practical reasons for caution. Topical ocular use is not supported by the data compiled for this report. Systemic aminoglycoside toxicity (ear and kidney damage) is a concern for a condition that is usually self-limiting. Safer topical aminoglycosides, such as tobramycin, are already established for eye infections.
Clinical Trial Evidence
Currently no related clinical trials registered.
Literature Evidence
The most relevant publications are listed below. Study-type labels follow the classification in the compiled data. Most items are reviews, case reports or microbiology surveys, and none is an RCT.
| PMID | Year | Type | Journal | Key Findings |
|---|---|---|---|---|
| 38298538 | 2023 | Review | Front Microbiol | Experimental and clinical data on tularemia treatment; conjunctivitis is one of its clinical presentations |
| 3317953 | 1987 | Review | Surv Ophthalmol | Review of tobramycin in ophthalmology; mentions streptomycin as the first aminoglycoside discovered |
| 19941479 | 2010 | Review | Curr Med Chem | Neglected bacterial diseases (Buruli ulcer, trachoma); rifampin/streptomycin combination is used for Buruli ulcer |
| 38941282 | 2024 | Case report | Am J Case Rep | Tularemia causing Parinaud oculoglandular syndrome (granulomatous conjunctivitis) |
| 6789462 | 1981 | Case report | S Afr Med J | Brucella keratoconjunctivitis after accidental splash exposure; treated with tetracyclines, co-trimoxazole, streptomycin and local chloramphenicol |
| 19584516 | 2009 | Case report | Indian J Med Microbiol | Familial tularaemia cases with pharyngitis and lymphadenitis |
| 22639311 | 2012 | Cohort | Mikrobiyol Bul | Clinical features of 35 tularemia cases in two outbreaks in Konya, Turkey |
| 21484175 | 2011 | Cohort | J Ophthalmic Inflamm Infect | Bacterial causes of conjunctivitis in Lagos, Nigeria, with antibiotic resistance and plasmid profiles |
| 15442493 | 1950 | Not classified | La Semana Medica | Primary tuberculous conjunctivitis treated with general and local streptomycin (no abstract) |
| 13075256 | 1953 | Not classified | Rev Int Trachome | Streptomycin and chloramine instillations for seasonal conjunctivitis in rural Morocco (no abstract) |
Singapore Market Information
| Authorization Number | Product Name | Dosage Form | Approved Indication |
|---|---|---|---|
| SIN01388P | Streptomycin Sulfate for Injection 1 g/vial | Injection, powder, for solution | Not stated in the available record |
Safety Considerations
- Contraindications suggested by the knowledge graph (not label text): kidney disease, pyoureter, hypercalcemia, nephrocalcinosis, phosphorus metabolism disorders, central nervous system origin vertigo, myasthenia gravis and other neuromuscular junction diseases, Parkinson disease and parkinsonian disorders.
- Drug Interactions: 100 interactions were found. Major-level interactions include:
- Botulinum toxin type A
- Human immunoglobulin G (intravenous)
- Bacitracin
Moderate-level interactions include other nephrotoxic or aminoglycoside agents (amphotericin B, amikacin, topical neomycin) and several NSAIDs (ibuprofen, ketorolac, celecoxib, aspirin).
- Aminoglycoside toxicity: As a class, aminoglycosides carry risks of ear and kidney toxicity. This is relevant to any non-life-threatening use such as conjunctivitis.
Please refer to the package insert for the full warnings and precautions.
Conclusion and Next Steps
Decision: Hold
Rationale: The prediction score is high, but there are no clinical trials, and the supporting literature is limited to reviews, old case reports and microbiology surveys. The risks of systemic aminoglycoside use outweigh the likely benefit in a mostly self-limiting condition, and safer topical alternatives already exist.
To proceed, the following is needed:
- Package insert warnings and contraindications from the Singapore regulator (HSA), which are currently missing and block safety screening
- Mechanism of action data from DrugBank
- Evidence for a topical ocular formulation, including safety and efficacy, or a narrower focus on pathogen-specific ocular infections (for example tularemic or tuberculous conjunctivitis)
- Comparative data against established topical agents such as tobramycin
Other Predicted Indications (for reference)
All have an evidence level of L4 or L5 and a recommendation of Hold.
| Rank | Predicted Indication | Score | Evidence Level | Note | |---|---|---|---|---| | 2 | Postinfectious vasculitis | 99.86% | L5 | No studies; no clear mechanistic rationale | | 3 | Post-bacterial disorder | 99.86% | L5 | No studies; non-specific category | | 4 | Post-infectious syndrome | 99.85% | L5 | No studies; persists after pathogen clearance | | 5 | Infective urethral stricture | 99.85% | L4 | Only old genitourinary tuberculosis reports (1964, 1976) | | 6 | Otitis externa | 99.85% | L4 | Only 1947-era human reports plus veterinary and in vitro work; ototoxicity concern | | 7 | Chagas cardiomyopathy | 99.83% | L5 | No studies; no antiparasitic activity | | 8 | Infection-related hemolytic uremic syndrome | 99.82% | L5 | Antibiotics are generally avoided; nephrotoxicity concern | | 9 | Lyme disease | 99.66% | L4 | Literature mostly on resistance mechanisms; standard therapy is safer | | 10 | Infectious otitis interna | 99.65% | L5 | Literature signals toxicity (vestibulotoxic and cochleotoxic); not supported |
Disclaimer
This content is for research purposes only and does not constitute medical advice. Clinical validation is required before any clinical application.