Streptomycin

Evidence Level: L4

Predicted Indications: 10

Streptomycin

Pharmacist Assessment Report

Streptomycin: From Pulmonary Tuberculosis to Conjunctivitis

One-Sentence Summary

Streptomycin is an aminoglycoside antibiotic, originally used to treat pulmonary tuberculosis and several other serious bacterial infections (plague, tularemia, brucellosis and others). The TxGNN model predicts it may be effective for conjunctivitis, but there are no registered clinical trials and only a handful of relevant publications, mostly case reports, reviews and historical papers. The evidence is therefore at the level of a research question, not a development candidate.

Quick Overview

Item	Content
Original Indication	Pulmonary tuberculosis (also chancroid, leptospirosis, lymphogranuloma venereum, yaws, necrotizing ulcerative gingivitis, brucellosis, tularemia, plague, granuloma inguinale)
Predicted New Indication	Conjunctivitis
TxGNN Prediction Score	0.9987
Evidence Level	L4
India Market Status	Listed in a compiled Indian medicine price dataset (4 of 4) – CDSCO approval status is not included in this data
Number of Listed Products	4 (valid: 4)
Recommended Decision	Hold

Why is This Prediction Reasonable?

Currently, detailed mechanism of action data is not available in the data compiled for this report. Streptomycin is known to be a bactericidal aminoglycoside that inhibits the 30S ribosomal subunit. It is active against Mycobacterium tuberculosis, Francisella tularensis and Brucella.

The most plausible link to conjunctivitis is through these pathogens. Tularemia can present as Parinaud oculoglandular syndrome (a granulomatous conjunctivitis), and brucellosis has been reported to cause keratoconjunctivitis. Older reports also describe tuberculous conjunctivitis treated with streptomycin.

This overlaps with streptomycin’s existing indications (tularemia, brucellosis, tuberculosis) and is not truly a separate new use. For ordinary bacterial conjunctivitis, no direct streptomycin evidence was found. Topical agents such as tobramycin are the usual treatment, and the review of tobramycin in ophthalmology in the data lists streptomycin only as a historical aminoglycoside.

Clinical Trial Evidence

Currently no related clinical trials registered.

Literature Evidence

Of the 20 publications retrieved, none is an RCT. The most relevant ones are shown below.

PMID	Year	Type	Journal	Key Findings
38298538	2023	Review	Frontiers in Microbiology	Tularemia treatment data; conjunctivitis is one of its clinical presentations
3317953	1987	Review	Survey of Ophthalmology	Review of tobramycin in ophthalmology; mentions streptomycin as the first aminoglycoside, no direct data on its ocular use
38941282	2024	Case report	American Journal of Case Reports	F. tularensis infection causing Parinaud oculoglandular syndrome
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 Bulteni	Clinical features of 35 tularemia cases in two outbreaks in Turkey
15442493	1950	Case report	La Semana Medica	Primary tuberculous conjunctivitis treated with general and local streptomycin
13075256	1953	Historical study	Revue internationale du trachome	Streptomycin and chloramine instillations for seasonal conjunctivitis in rural Morocco
19941479	2010	Review	Current Medicinal Chemistry	Neglected bacterial diseases (Buruli ulcer, trachoma); rifampin/streptomycin used for Buruli ulcer

India Market Information

Authorization Number	Product Name	Dosage Form	Approved Indication
Registration No. 95257	Genpod 200mg Tablet	Strip of 10 tablets	Not specified
Registration No. 142359	MERSTREP 1GM INJECTION	Vial of 1 injection	Not specified
Registration No. 459	Ambistryn-S 0.75gm Injection	Vial of 1 powder for injection	Not specified
Registration No. 786	Ambistryn-S 1gm Injection	Vial of 1 injection	Not specified

No ophthalmic (eye drop) formulation is registered; only oral and injectable products are available.

Safety Considerations

Contraindications (from the knowledge graph, 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 disorders and Parkinson disease.
Drug Interactions: 177 interactions were identified. Major interactions include botulinum toxin type A, intravenous human immunoglobulin G and bacitracin. Notable moderate interactions include other nephrotoxic or aminoglycoside agents (amikacin, amphotericin B, topical neomycin), NSAIDs (ibuprofen, ketorolac, celecoxib, aspirin) and bisphosphonates (alendronic acid, risedronic acid, ibandronate).
Other considerations from the evidence: Aminoglycosides carry known risks of ototoxicity (vestibular and cochlear) and nephrotoxicity. These are particularly relevant to the ear-related predictions below.

Please refer to the package insert for full warnings, as label text was not available.

Other Predicted Indications (Lower Priority)

Rank	Predicted Indication	Score	Evidence Level	Assessment
2	Postinfectious vasculitis	0.9986	L5	No evidence; immune-mediated, antibacterial unlikely to help
3	Post-bacterial disorder	0.9986	L5	No evidence; vague category
4	Post-infectious syndrome	0.9985	L5	No evidence; non-specific category
5	Infective urethral stricture	0.9985	L5	Only historical TB case reports; extension of the TB indication, does not reverse fibrotic strictures
6	Otitis externa	0.9985	L5	1947 case series and veterinary or in vitro data; ototoxicity concern
7	Chagas cardiomyopathy	0.9983	L5	No evidence; the pathogen is a protozoan
8	Infection-related hemolytic uremic syndrome	0.9982	L5	Conflicts with standard care (antibiotics avoided in STEC-HUS; nephrotoxicity)
9	Lyme disease	0.9966	L4	Literature concerns resistance genes as lab markers, not therapy; standard drugs are effective
10	Infectious otitis interna	0.9965	L5	Likely false positive; streptomycin is vestibulotoxic and cochleotoxic

Conclusion and Next Steps

Decision: Hold

Rationale: The conjunctivitis prediction has a high model score but no clinical trials, and the supporting literature consists of case reports, reviews and historical papers. Most of it concerns tularemia, brucellosis or tuberculosis, which are already streptomycin indications. Evidence for common bacterial conjunctivitis is absent, and topical agents are the standard of care. The remaining predictions are either unsupported or conflict with streptomycin’s safety profile.

To proceed, the following is needed:

Package insert warnings and contraindications from the manufacturers (currently missing, and this blocks safety screening)
Detailed mechanism of action data from DrugBank
A decision on whether the conjunctivitis use is wanted at all, given that it largely overlaps with existing indications (tularemia, brucellosis, tuberculosis)
If pursued, a review of ocular safety and an appropriate topical formulation, since only oral and injectable products are marketed in India
Systematic confirmation that no better-supported comparators (for example, tobramycin and other standard topical agents) already cover the use
Disclaimer

This content is for research purposes only and does not constitute medical advice. Clinical validation is required before any clinical application.