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The early bactericidal activity of streptomycin
P R Donald1, F A Sirgel, A Venter
1Department of Paediatrics, University of Stellenbosch, Cape Town, South Africa.
Summary
Streptomycin (SM) shows dose-related, low bactericidal activity against tuberculosis bacilli in cavities. Paromomycin may be a better choice if streptomycin-resistant bacteria are present.
Area of Science:
- Microbiology
- Pharmacology
- Infectious Diseases
Background:
- Pulmonary tuberculosis (TB) remains a significant global health challenge.
- Early bactericidal activity (EBA) is a key measure of anti-TB drug efficacy.
- Streptomycin (SM) is a first-line TB treatment, but its early bactericidal effect requires further characterization.
Purpose of the Study:
- To determine the early bactericidal activity (EBA) of streptomycin (SM) in patients with newly diagnosed pulmonary tuberculosis.
- To assess the dose-response relationship of SM's bactericidal activity.
- To compare the EBA of SM with that of paromomycin.
Main Methods:
- Patients with sputum smear-positive pulmonary TB received daily doses of 7.5, 15, or 30 mg/kg of SM.
- Early bactericidal activity was measured by the fall in viable tubercle bacilli counts in sputum over the first 48 hours of treatment.
- Standard biological assay methods were used for comparison with paromomycin.
Main Results:
- An EBA of 0.133 was observed with 30 mg/kg SM, significantly different from zero (P=0.0009).
- Lower doses of SM (15 mg/kg and 7.5 mg/kg) showed minimal to no significant EBA.
- Paromomycin was not found to be significantly more potent than SM.
Conclusions:
- Streptomycin exhibits low, dose-dependent bactericidal activity in TB cavities.
- These findings align with previous clinical trial results.
- Paromomycin is suggested as a potential alternative if streptomycin-resistant TB strains are suspected.