Capreomycin

What it is and how it works

Capreomycin, obtained from Streptomyces capreolus, binds to the bacterial 70S ribosome and inhibits protein synthesis in Mycobacterium tuberculosis. It is bacteriostatic to bactericidal and shows partial cross-resistance with amikacin and kanamycin.

Indications

Multidrug-resistant tuberculosis, in combination with other antituberculosis drugs, when first-line agents cannot be used; current WHO guidance no longer recommends injectable agents of this class in most regimens.

Dosage and administration (summary)

Intramuscular injection (or intravenous infusion): typically 15 mg/kg (maximum 1 g) once daily for the intensive phase, then two to three times weekly; reduce dose or frequency in renal impairment and in the elderly.

Contraindications

Hypersensitivity to capreomycin; pregnancy; concomitant use with other parenteral ototoxic or nephrotoxic antimycobacterials (e.g. streptomycin, amikacin, kanamycin).

Warnings and precautions

Nephrotoxicity and eighth cranial nerve toxicity (hearing loss, tinnitus, vestibular dysfunction) are dose-related; monitor renal function, audiometry and vestibular function before and during treatment. Hypokalaemia, hypomagnesaemia and hypocalcaemia are common and require electrolyte monitoring. Neuromuscular blockade may occur, particularly with anaesthetics or muscle relaxants.

Pregnancy

Contraindicated in pregnancy because of the risk of fetal ototoxicity and nephrotoxicity.

Storage and supply

Store unopened vials at 2–8 °C; reconstituted solution may be kept refrigerated for a limited period per the manufacturer.

Source: reference summary prepared from the EU SmPC/EPAR, BNF and WHO Model Formulary. The approved product information in Iran governs.