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Kanamycin Sulfate

Pronunciation: kan-uh-MY-sin SULL-fate
Class: Aminoglycoside

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Trade Names

Kantrex
- Capsules 500 mg
- Injection 500 mg
- Injection 1 g
- Pediatric Injection 75 mg

Pharmacology

Inhibits production of bacterial protein, causing cell death.

Pharmacokinetics

Absorption

Rapidly absorbed after IM injection. T _max is approximately 1 h. C _max is 22 mcg/mL (from the 7.5 mg/kg dose). Poorly absorbed from the normal GI tract (orally).

Distribution

Diffuses rapidly into most body fluids including synovial and peritoneal fluids and bile. Significant levels of drug appear in cord blood and amniotic fluid.

Metabolism

Little if any metabolic transformation occurs.

Elimination

Plasma t _½ is 2 h.

Excreted almost entirely by glomerular filtration and is not reabsorbed by the renal tubules. Renal excretion is extremely rapid. The unabsorbed portion is eliminated unchanged in the feces.

Duration

48 to 72 h

Special Populations

Renal Function Impairment

Patients with renal function impairment or diminished glomerular pressure excrete kanamycin more slowly. May build up excessively high blood levels that lead to increased risk of ototoxic reactions.

Severely burned patients

In severely burned patients, t _½ may significantly decrease. As result serum concentrations may be lower.

Indications and Usage

Parenteral

Short-term treatment of serious infections caused by susceptible strains of microorganisms, especially gram-negative bacteria.

Oral

Short-term adjunctive therapy for suppression of intestinal bacteria; treatment of hepatic coma.

Contraindications

Hypersensitivity to aminoglycosides; intestinal obstruction (oral). Generally not indicated for long-term therapy (more than 14 days) because of ototoxicity and nephrotoxicity.

Dosage and Administration

Infection
Adults and Children

IM/IV 15 mg/kg/day in 2 to 4 divided doses. Do not exceed 1.5 g/day.

Suppression of Intestinal Bacteria
Adults

PO 1 g every hour for 4 h, then 1 g every 6 h for 36 to 72 h.

Tuberculosis
Adults and children

IM/IV 15 to 30 mg/kg/day (max, 1 g/day).

Hepatic Coma
Adults

PO 8 to 12 g/day in divided doses.

General Advice

For IV administration, dilute each 500 mg with 100 to 200 mL or more of sodium chloride 0.9% or D5W. Give slowly over 30 to 60 min.
Give IM injection deeply into upper outer quadrant of gluteal muscle.

Storage/Stability

Store at room temperature. Darkening of vials during shelf life does not indicate loss of potency.

Drug Interactions

Beta-lactam antibiotics (eg, cephalosporins, penicillins)

Do not mix in IV solutions.

Digoxin, methotrexate, vitamin A, vitamin K

Oral kanamycin may decrease absorption of these drugs.

Drugs with nephrotoxic potential (eg, amphotericin, cephalosporins, enflurane, methoxyflurane, vancomycin)

Increased risk of nephrotoxicity.

Loop diuretics

Increased auditory toxicity.

Neuromuscular blocking agents

Enhanced effects of these agents.

Polypeptide antibiotics

Increased risk of respiratory paralysis and renal function impairment.

Laboratory Test Interactions

None well documented.

Adverse Reactions

CNS

Neuromuscular blockade.

EENT

Hearing loss; deafness; loss of balance.

GI

Malabsorption syndrome (eg, increased fecal fat, decreased serum carotene, fall in xylose absorption); nausea; vomiting; diarrhea.

Genitourinary

Oliguria; proteinuria; elevated serum creatinine and BUN; granular casts; red and white cells in urine; decreased CrCl.

Respiratory

Apnea.

Miscellaneous

Pain and irritation at injection site; acute muscular paralysis; hypomagnesemia.

Precautions

Warnings

Neurotoxicity

Manifests as both auditory and vestibular ototoxicity, and primarily occurs in patients with preexisting renal damage with prolonged therapy. Partial or total irreversible deafness may continue to develop after drug is stopped. Other features of neurotoxicity include paresthesia, twitching, and seizures.

Nephrotoxicity

Usually reversible.

Teratogenic in pregnancy.

Closely monitor renal and eighth nerve function in patients with suspected renal function impairment. Monitor peak and trough concentrations. Dosage adjustments are required in renal function impairment.

Pregnancy

Category D .

Lactation

Excreted in breast milk.

Children

Use cautiously in premature infants and newborns because of renal immaturity.

Neuromuscular blockade

Use with caution in patients with neuromuscular disorders, those receiving anesthesia or muscle relaxants, hypomagnesemia, hypocalcemia, hypokalemia, or in newborns whose mothers received magnesium sulfate.

Oral absorption

Increased absorption (and potential for toxicity) when intestinal mucosa is ulcerated or denuded.

Overdosage

Symptoms

Nephrotoxicity, auditory toxicity, vestibular toxicity, neuromuscular blockade, respiratory paralysis.

Patient Information

Advise patient that drug may cause nausea, vomiting, or diarrhea.
Instruct patient to drink plenty of fluids while taking medication.
Emphasize importance of follow-up visits and serial audiograms, because ototoxicity may be asymptomatic.
Instruct patient to report the following symptoms to health care provider: ringing in ears, hearing impairment, rash, difficulty urinating, or dizziness.