Streptomycin
| Evidence Level: L4 | Predicted Indications: 10 |
Table of Contents
Streptomycin: Conjunctivitis
One-Sentence Summary
Streptomycin is an aminoglycoside antibiotic originally used for pulmonary tuberculosis and other serious bacterial infections, such as plague, tularemia and brucellosis. The TxGNN model predicts it may be effective for conjunctivitis. No clinical trials are registered, and the 20 publications retrieved are mostly case reports, reviews and laboratory or veterinary studies, so the evidence is weak.
Quick Overview
| Item | Content |
|---|---|
| Original Indication | Not recorded in the local data |
| Predicted New Indication | Conjunctivitis |
| TxGNN Prediction Score | 0.9987 |
| Evidence Level | L4 |
| Canada Market Status | Approved but not marketed (approvals on record: 1) |
| Number of DINs | 1 (marketed: 0) |
| Recommended Decision | Hold |
Why is This Prediction Reasonable?
Currently, detailed mechanism of action data is not available in the data compiled for this report. Based on general pharmacology, streptomycin is an aminoglycoside that inhibits bacterial protein synthesis by binding the 30S ribosomal subunit. Its efficacy against tuberculosis and several other bacterial infections is established.
Bacterial conjunctivitis can be caused by organisms that streptomycin is known to act on. Examples in the literature include oculoglandular tularemia (Parinaud syndrome), Brucella keratoconjunctivitis and tuberculous conjunctivitis. In these reports the eye disease is part of a systemic infection that was treated with streptomycin, usually with other drugs.
Several caveats limit the prediction. No study tests streptomycin as a treatment for conjunctivitis itself, and topical ophthalmic use is not established. Other aminoglycosides, such as tobramycin, are already used for this purpose.
The other predicted indications are weaker. Postinfectious vasculitis, post-bacterial disorder, post-infectious syndrome, Chagas cardiomyopathy and infection-related hemolytic uremic syndrome have no supporting evidence, and some have no plausible mechanism. For hemolytic uremic syndrome, antibiotics may even be harmful. Infective urethral stricture, otitis externa, Lyme disease and infectious otitis interna have only historical, indirect, laboratory or veterinary evidence.
Clinical Trial Evidence
Currently no related clinical trials registered.
Literature Evidence
The retrieved literature is dominated by reviews, case reports and non-human studies. No RCTs were found.
| PMID | Year | Type | Journal | Key Findings |
|---|---|---|---|---|
| 38298538 | 2023 | Review | Frontiers in Microbiology | Experimental and clinical data on tularemia treatment. Ocular (conjunctivitis) presentations are among the clinical forms. |
| 3317953 | 1987 | Review | Survey of Ophthalmology | Review of tobramycin in ophthalmology. It notes that streptomycin was the first aminoglycoside discovered, so the evidence relates to a different drug. |
| 38941282 | 2024 | Case report | American Journal of Case Reports | Francisella tularensis infection causing Parinaud oculoglandular syndrome (granulomatous conjunctivitis). |
| 6789462 | 1981 | Case report | South African Medical Journal | Brucella keratoconjunctivitis after accidental vaccine splash. Treated with tetracyclines, co-trimoxazole and streptomycin, plus local chloramphenicol. |
| 19584516 | 2009 | Case report | Indian Journal of Medical Microbiology | Familial tularaemia cases with pharyngitis and lymphadenitis. |
| 22639311 | 2012 | Cohort | Mikrobiyoloji Bülteni | Clinical and laboratory features of 35 tularemia cases from two outbreaks in Konya, Turkey. |
| 21484175 | 2011 | Cohort | Journal of Ophthalmic Inflammation and Infection | Bacterial causes of conjunctivitis in Lagos, Nigeria, with antibiotic resistance and plasmid profiles. |
| 19941479 | 2010 | Review | Current Medicinal Chemistry | Neglected bacterial diseases (Buruli ulcer, trachoma). Rifampin/streptomycin is mentioned for Buruli ulcer. |
| 15442493 | 1950 | Not classified | La Semana Médica | Primary tuberculous conjunctivitis treated with general and local streptomycin. |
| 13075256 | 1953 | Not classified | Revue Internationale du Trachome | Streptomycin and chloramine instillations for seasonal conjunctivitis in rural Morocco. |
Canada Market Information
| DIN | Product Name | Dosage Form | Approved Indication |
|---|---|---|---|
| 02243660 | STREPTOMYCIN FOR INJECTION USP | Not specified | Not specified |
Safety Considerations
Contraindication signals from the knowledge graph (these are not label text): kidney disease, pyoureter, hypercalcemia, nephrocalcinosis, phosphorus metabolism disease, central nervous system-origin vertigo, myasthenia gravis (including adult-onset), neuromuscular junction disease, parkinsonian disorder and Parkinson disease.
Drug interactions (100 recorded, of which the first 20 were retrieved):
- Major: botulinum toxin type A, intravenous human immunoglobulin G, bacitracin.
- Moderate: amikacin, neomycin (topical), amphotericin B (including lipid complex), NSAIDs (ibuprofen, ketorolac, celecoxib, acetylsalicylic acid), bisphosphonates (alendronic acid, risedronic acid, ibandronate), estrogens (estradiol, ethinylestradiol), rabeprazole, mesalazine and balsalazide.
- Minor: lidocaine.
Class-level concerns raised in the evidence:
- Streptomycin is vestibulotoxic and cochleotoxic. One 1964 report describes streptomycin-induced labyrinthitis.
- In Shiga toxin-associated hemolytic uremic syndrome, antibiotics may worsen outcomes.
Please refer to the package insert for complete warnings and contraindications.
Conclusion and Next Steps
Decision: Hold
Rationale: The model score is very high, but there are no clinical trials and no direct evidence for conjunctivitis. The literature consists of case reports of systemic infections with eye involvement, plus laboratory and veterinary work. Established alternatives such as tobramycin already exist. The safety profile is also a concern, with kidney, neuromuscular and ear-related toxicity signals.
To proceed, the following is needed:
- The Health Canada package insert, to confirm approved indications, warnings and contraindications. This is a blocking gap.
- Mechanism of action data from DrugBank.
- Evidence on topical ophthalmic formulation, route feasibility and ocular tolerability, since only an injectable product is licensed in Canada.
- Comparative data against current standard ophthalmic antibiotics.
- A review of the specific infections (tularemia, brucellosis, ocular tuberculosis) in which streptomycin might serve as systemic therapy for ocular involvement.
Disclaimer
This content is for research purposes only and does not constitute medical advice. Clinical validation is required before any clinical application.