Capreomycin (Capastat) is a polypeptide antibiotic derived from Streptomyces capreolus. It is bacteriostatic against most strains of M. tuberculosis, including the MDR strain. In addition, it is active against M. kansasii, M. avium, and in high concentrations, some grampositive and gram-negative bacteria. Like other antitubercular drugs, resistance to capreomycin occurs rapidly if the drug is used alone. There is no cross-resistance between streptomycin and capreomycin, but some isolates resistant to capreomycin are resistant to viomycin.
Capreomycin is poorly absorbed from GI tract and so must be given parenterally. It is excreted mainly unchanged in the urine following glomerular filtration. Capreomycin is a used as a second-line agent in combination with other drugs. It appears to be particularly useful in multidrug regimens for the treatment of drug-resistant tuberculosis, especially with streptomycin resistance. Capreomycin is associated with ototoxicity and nephrotoxicity, and these adverse effects can be severe in patients with preexisting renal insufficiency.
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