Capreomycin

Summary

Capreomycin is a cyclic polypeptide antibiotic derived from Streptomyces capreolus, used as a second-line injectable agent in the treatment of multidrug-resistant tuberculosis (MDR-TB). It is administered parenterally and is typically used in combination with other anti-tuberculosis agents when first-line drugs have failed or are contraindicated.

Mechanism of Action

Inhibits bacterial protein synthesis by binding to the 70S ribosome, interfering with translocation and peptide elongation; also disrupts ribosomal function by binding 16S and 23S rRNA at their interface.

Routes of Administration

Goals & Uses

• Treatment of pulmonary tuberculosisInfectious DiseaseHigh
• Treatment of multidrug-resistant tuberculosis (MDR-TB)Infectious DiseaseHigh
• Treatment of extensively drug-resistant tuberculosis (XDR-TB)Infectious DiseaseModerate

Contraindications

• Hypersensitivity to capreomycinAllergyHigh
• Concurrent use of other aminoglycosides or polypeptide antibioticsDrug InteractionHigh
• Severe renal impairmentOrganHighKidney function concerns

Adverse Effects

• Leukocytosis or leukopeniaHematologicUncommon
• OtotoxicityAuditory/vestibularCommon
• Electrolyte disturbancesMetabolicCommon
• Injection site pain and indurationLocalCommon
• Neuromuscular blockadeNeuromuscularRare
• NephrotoxicityRenalCommon

Drug Interactions

• Aminoglycosides (e.g., streptomycin, amikacin)High
• Neuromuscular blocking agents (e.g., succinylcholine, vecuronium)High
• Nephrotoxic drugs (e.g., NSAIDs, vancomycin, amphotericin B)Moderate
• Loop diuretics (e.g., furosemide, ethacrynic acid)Moderate

Population Constraints

• PregnancyReproductive SafetyRelative
• Patients with pre-existing hearing lossComorbidityRelative
• Renal impairmentOrgan ImpairmentRelative
• Pediatric patientsAgeRelative
• Elderly patientsAgeRelative

Regulatory Status

• European UnionUnknownUsed in clinical practice for MDR-TB under WHO guidelines; approval status varies by member state
• United StatesApprovedApproved: Pulmonary tuberculosis caused by susceptible strains of Mycobacterium tuberculosis when primary agents have failedApproved by FDA; marketed as Capastat Sulfate; second-line agent
• United KingdomUnknownAvailable as a second-line anti-TB agent; use guided by WHO and national TB guidelines

FDA-approved for use in pulmonary tuberculosis caused by susceptible strains of Mycobacterium tuberculosis when primary agents have failed. Classified as a second-line anti-TB drug by WHO.

Evidence & Sources

No sources recorded yet.