What this test measures
This test determines whether a cultured M. tuberculosis isolate is sensitive or resistant to streptomycin (S) at the WHO-defined critical concentration. Streptomycin is the original anti-TB drug, an injectable aminoglycoside that inhibits bacterial protein synthesis. Resistance is mediated by mutations in rpsL and rrs genes.
Why it matters
Streptomycin is rarely used in modern TB treatment in India. It has been largely replaced by oral first-line drugs and, in MDR-TB, by amikacin or capreomycin where an injectable is still needed. Streptomycin DST is still reported in many Indian labs as part of the classical SIRE/SIREP first-line panel, and is useful for:
- Surveillance of overall aminoglycoside resistance trends. - Patients on legacy regimens. - Occasional salvage scenarios where streptomycin remains the only injectable option.
Like all aminoglycosides, streptomycin has ototoxic and nephrotoxic effects, and is generally avoided in pregnancy.
How to prepare
A positive M. tuberculosis culture (MGIT or LJ) is required. If not yet available, sputum samples must be collected for AFB culture first.
Markers & reference ranges
Reference ranges below are typical adult values. Your lab's reported range may differ slightly based on the assay platform and patient demographics — always read your report against the range printed on it.
Streptomycin vs other aminoglycosides
| Drug | Class | Use today in TB |
|---|---|---|
| Streptomycin | Aminoglycoside (old) | Rarely used |
| Kanamycin | Aminoglycoside | Largely phased out |
| Amikacin | Aminoglycoside | Preferred injectable when needed |
| Capreomycin | Cyclic peptide | Alternative injectable |
Frequently asked questions
Why is streptomycin still tested?
It is part of the classical SIRE/SIREP first-line panel and useful for surveillance. Streptomycin resistance is part of the WHO drug-resistance survey data and informs national TB epidemiology.
Is streptomycin still used clinically?
Rarely. Modern regimens have largely replaced it. Streptomycin is reserved for very specific scenarios.
What are the side effects?
Hearing loss, balance issues, kidney injury — and rashes, fever. Audiometry and creatinine are monitored when used.
If I am streptomycin-resistant, will amikacin work?
Usually yes — streptomycin and amikacin / kanamycin have different resistance mechanisms (rpsL vs rrs), so cross-resistance is limited.
How long does the test take?
About 1–2 weeks from a positive culture; 4–6 weeks total from sputum collection.
Is the test available under NTEP?
Yes — first-line DST including streptomycin is offered at NTEP intermediate and national reference labs.
Is streptomycin used in pregnancy?
Streptomycin is generally avoided in pregnancy because of fetal ototoxicity. Safer alternatives are preferred.
Related Tuberculosis / Mycobacterial tests
Tests commonly ordered alongside ANTIBIOGRAM - MTB (STREPTOMYCIN), or that help interpret an unexpected result.
Sources & references
- WHO Consolidated Guidelines on Drug-Resistant TB · accessed 2026-05-30T00:00:00.000Z
- NTEP PMDT Guidelines · accessed 2026-05-30T00:00:00.000Z
- India TB Report 2024 · accessed 2026-05-30T00:00:00.000Z
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