Capreomycin
Also known as: Capastat Sulfate, Capreomycin, Capreomycin sulfate, CMY, CPM, TB‑112
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Summary
Capreomycin is an approved cyclic peptide antibiotic used as part of injectable regimens for multidrug‑resistant tuberculosis (MDR‑TB). It is administered by intramuscular or intravenous injection and is listed among second‑line drugs for patients whose disease is resistant to first‑line agents.
Mechanism of Action
The cited literature does not detail the molecular mechanism of capreomycin. It is classified as a cyclic peptide antibiotic used against Mycobacterium tuberculosis, and such agents typically interfere with bacterial protein synthesis, but the abstracts provide no specific mechanistic data.
What the Research Shows
A 2024 systematic review of targeted next‑generation sequencing reported that genetic tests detect capreomycin resistance with a sensitivity of about 76.5% and high specificity, indicating that resistance monitoring is feasible but not perfectly sensitive. A 2021 review identified capreomycin among non‑aminoglycoside antibiotics linked to ototoxicity, especially in neonates. An individual‑patient data meta‑analysis of MDR‑TB treatment (2020) found capreomycin associated with permanent drug discontinuation in roughly 8.2% of patients, a higher rate than fluoroquinolones or bedaquiline. Together, these studies highlight capreomycin’s role in MDR‑TB therapy, its resistance‑testing challenges, and notable safety concerns.
Reported Benefits
Capreomycin provides an oral‑injection option for patients with drug‑resistant TB when other agents are ineffective, contributing to cure rates in MDR‑TB regimens. Its inclusion in WHO‑recommended treatment algorithms reflects clinical utility, and genetic testing can identify resistance in most cases, guiding therapy adjustments.
Limitations of the Evidence
Evidence shows moderate sensitivity (≈76%) for detecting capreomycin resistance via targeted sequencing, leaving some resistant strains undetected. The drug carries a relatively high risk of adverse events leading to permanent discontinuation (≈8%) and ototoxicity, particularly in vulnerable populations. Administration requires injection, limiting outpatient use, and data on long‑term outcomes are limited to observational cohorts.
Safety Considerations
Capreomycin is associated with ototoxicity, especially in neonates, and a notable incidence of severe adverse events that prompt permanent discontinuation (about 8%). Monitoring for hearing loss and other toxicities is essential during therapy. The injectable route may cause local reactions, and clinicians should weigh these risks against therapeutic benefits.
How It Is Administered
Capreomycin is supplied as a sulfate salt for intramuscular or intravenous injection. Dosing regimens are determined by treating physicians based on disease severity and patient factors; the drug is not given orally.
Routes of Administration
Goals & Uses
- Treatment of pulmonary tuberculosisInfectious DiseaseHigh
- Treatment of multidrug‑resistant 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 impairment (eGFR <30 mL/min)RenalModerate
- Severe renal impairmentOrganHighKidney function concerns
- Known hypersensitivity to capreomycinAllergyHigh
Adverse Effects
- Leukocytosis or leukopeniaHematologicUncommon
- OtotoxicityAuditory/vestibularCommon
- Electrolyte disturbancesMetabolicCommon
- Injection site pain and indurationLocalCommon
- Neuromuscular blockadeNeuromuscularUncommon
- 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
- Non‑depolarizing neuromuscular blockersModerate
- Aminoglycosides (e.g., gentamicin)High
Population Constraints
- PregnancyReproductive SafetyRelative
- Patients with pre-existing hearing lossComorbidityRelative
- Neonates and infantsPediatricRelative
- Renal impairmentOrgan ImpairmentRelative
- Pediatric patientsAgeRelative
- Elderly patientsAgeRelative
Regulatory Status
- European UnionInvestigationalNot marketed; may be accessed via compassionate use programs
- United StatesApprovedApproved: multidrug‑resistant tuberculosisFDA approved as injectable formulation
- United KingdomApprovedApproved: multidrug‑resistant tuberculosisAvailable through specialist TB centers
Approved in the United States and several other jurisdictions for MDR‑TB; limited availability in Europe.
Evidence & Sources
- Journal ArticleHighSchwab TC, et al.2024-01-01T00:00:00.000000Z
- Journal ArticleModerateRybak LP, Ramkumar V, Mukherjea D2021-01-01T00:00:00.000000Z
- Journal ArticleHighLan Z, et al.2020-01-01T00:00:00.000000Z
Frequently Asked Questions
What type of infection is capreomycin used to treat?
Capreomycin is used as part of injectable combination therapy for multidrug‑resistant tuberculosis, especially when first‑line drugs are ineffective.
How is capreomycin given?
It is administered by injection, either intramuscularly or intravenously, as a sterile solution of the sulfate salt.
What are the main safety concerns?
The drug can cause ototoxicity, particularly in newborns, and has an 8% rate of severe adverse events that may require stopping treatment permanently.
Can resistance to capreomycin be detected quickly?
Targeted next‑generation sequencing can identify resistance with about 76% sensitivity and high specificity, but some resistant strains may be missed.
Why might a clinician choose capreomycin over other drugs?
When a patient’s TB strain is resistant to first‑line agents and other second‑line options are unsuitable, capreomycin offers an injectable option that can still contribute to cure, despite its higher toxicity profile.
What is Capreomycin?
Capreomycin is an approved cyclic peptide antibiotic used as part of injectable regimens for multidrug‑resistant tuberculosis (MDR‑TB). It is administered by intramuscular or intravenous injection and is listed among second‑line drugs for patients whose disease is resistant to first‑line agents.
What is Capreomycin used for?
Capreomycin is educationally associated with: Treatment of pulmonary tuberculosis, Treatment of multidrug‑resistant tuberculosis, Treatment of multidrug-resistant tuberculosis (MDR-TB), Treatment of extensively drug-resistant tuberculosis (XDR-TB). Educational only — not medical advice.
How is Capreomycin administered?
Recorded routes of administration: Intramuscular, Intravenous.
What are the potential side effects of Capreomycin?
Reported adverse effects include: Leukocytosis or leukopenia, Ototoxicity, Electrolyte disturbances, Injection site pain and induration, Neuromuscular blockade, Nephrotoxicity. This list is not exhaustive — consult a qualified clinician.
Who should avoid Capreomycin?
Recorded contraindications: Hypersensitivity to capreomycin, Concurrent use of other aminoglycosides or polypeptide antibiotics, Severe renal impairment (eGFR <30 mL/min), Severe renal impairment, Known hypersensitivity to capreomycin. Consult a qualified clinician before use.