Streptomycin and alternative agents for the treatment of tularemia: review of the literature

Clin Infect Dis. 1994 Jul;19(1):42-7. doi: 10.1093/clinids/19.1.42.


Because of the recent lack of availability of streptomycin--currently considered the drug of choice for the treatment of tularemia--we reviewed the literature on alternative drugs that have been used for this purpose. In addition, we reviewed data on the in vitro susceptibility of Francisella tularensis to a wide variety of agents. The rate of cure for streptomycin was 97%, with no relapses. For gentamicin and tetracycline, respectively, the rates of cure were 86% and 88%, the rates of relapse were 6% and 12%, and the rates of failure were 8% and 0. The duration of therapy with gentamicin and a delay in its initiation may have affected outcome in severe cases. For chloramphenicol and tobramycin, cure rates were 77% and 50%, respectively; relapse rates were 21% and 0; and failure rates were 2% and 33%, respectively. Treatment with imipenem/cilastatin was successful in one case, and that with ciprofloxacin or norfloxacin was successful in six cases; in contrast, therapy with ceftriaxone was ineffective in eight cases. On the basis of this review, we conclude that gentamicin is an acceptable alternative to streptomycin for the treatment of tularemia.

Publication types

  • Review

MeSH terms

  • Francisella tularensis / drug effects
  • Francisella tularensis / isolation & purification
  • Gentamicins / therapeutic use*
  • Humans
  • Microbial Sensitivity Tests
  • Streptomycin / therapeutic use*
  • Tetracycline / therapeutic use*
  • Tularemia / drug therapy*


  • Gentamicins
  • Tetracycline
  • Streptomycin