(kan a MYE sin)
- Kanamycin Sulfate
Excipient information presented when available (limited, particularly for generics); consult specific product labeling. [DSC] = Discontinued product
Generic: 1 g/3 mL (3 mL) [DSC]
- Antibiotic, Aminoglycoside
Interferes with protein synthesis in bacterial cell by binding to ribosomal subunit
Vd: ~0.3 L/kg:
Relative diffusion from blood into CSF: Good only with inflammation (exceeds usual MICs)
CSF:blood level ratio: Normal meninges: Nil; Inflamed meninges: 43%
Urine (as unchanged drug)
Time to Peak
Serum: IM: 1-2 hours (decreased in burn patients)
2-4 hours; Anuria: 80 hours; End-stage renal disease: 40-96 hours
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.
Special Populations Note
Burn patients: Half-life may significantly decrease, resulting in decreased serum concentrations.
Use: Labeled Indications
Treatment of serious infections caused by susceptible strains of E. coli, Proteus species, Enterobacter aerogenes, Klebsiella pneumoniae, Serratia marcescens, and Acinetobacter species; second-line treatment of Mycobacterium tuberculosis
Hypersensitivity to kanamycin, any component of the formulation, or other aminoglycosides; pregnancy
Note: Kanamycin injection is no longer available in the US.
Note: Dosing should be based on ideal body weight
Susceptible systemic infections: IM, IV: 5-7.5 mg/kg/dose in divided doses every 8-12 hours (<15 mg/kg/day)
Following surgical contamination, peritonitis: Intraperitoneal: 500 mg
Irrigating solution: 0.25%; maximum 1.5 g/day (via all administration routes)
Aerosol: 250 mg 2-4 times/day
IM, IV: Initial dose should be 5-7.5 mg/kg based on ideal body weight (except in obese patients); maintenance dose and interval should be adjusted for estimated renal function; dosing interval in most older patients is every 12-24 hours (see Dosing in Renal Impairment).
Note: Kanamycin injection is no longer available in the US.
Note: Dosing should be based on ideal body weight
Infections: IM, IV: 15 mg/kg/day in divided doses every 8-12 hours
Dosing: Renal Impairment
Adults: IV: The following adjustments have been recommended (Aronoff, 2007). Note: Renally adjusted dose recommendations are based on a dose of 7.5 mg/kg every 12 hours.
CrCl >50 mL/minute: Administer every 12-24 hours
CrCl 10-50 mL/minute: Administer every 24-72 hours; monitor levels.
CrCl <10 mL/minute: Administer every 48-72 hours; monitor levels.
Intermittent hemodialysis (IHD): One-half the dose administered after hemodialysis on dialysis days.
Peritoneal dialysis (PD): Administration via PD fluid: 15-20 mg/L/day of PD fluid
Continuous renal replacement therapy (CRRT): Administer every 24-72 hours; monitor levels. Note: Drug clearance is highly dependent on the method of renal replacement, filter type, and flow rate. Appropriate dosing requires close monitoring of pharmacologic response, signs of adverse reactions due to drug accumulation, as well as drug concentrations in relation to target trough (if appropriate).
Dosing: Hepatic Impairment
No dosage adjustment provided in manufacturer’s labeling.
IV: Must be further diluted prior to IV infusion. For adults, dilute 500 mg in 100 to 200 mL of D5W or NS or 1 g in 200 to 400 mL. For pediatric patients, use sufficient amount to infuse solution over 30-60 minutes.
Intraperitoneal: Dilute dose in 20 mL sterile distilled water.
Aerosol: Dilute 250 mg in 3 mL normal saline.
IM: Administer deeply in upper outer quadrant of the gluteal muscle.
IV: Infuse over 30-60 minutes.
Some penicillins (eg, carbenicillin, ticarcillin and piperacillin) have been shown to inactivate aminoglycosides in vitro. This has been observed to a greater extent with tobramycin and gentamicin, while amikacin has shown greater stability against inactivation. Concurrent use of these agents may pose a risk of reduced antibacterial efficacy in vivo, particularly in the setting of profound renal impairment. However, definitive clinical evidence is lacking. If combination penicillin/aminoglycoside therapy is desired in a patient with renal dysfunction, separation of doses (if feasible), and routine monitoring of aminoglycoside levels, CBC, and clinical response should be considered.
Store vial at controlled room temperature. Darkening of vials does not indicate loss of potency.
AbobotulinumtoxinA: Aminoglycosides may enhance the neuromuscular-blocking effect of AbobotulinumtoxinA. Monitor therapy
Amphotericin B: May enhance the nephrotoxic effect of Aminoglycosides. Monitor therapy
Arbekacin: May enhance the nephrotoxic effect of Aminoglycosides. Arbekacin may enhance the ototoxic effect of Aminoglycosides. Monitor therapy
Ataluren: May enhance the adverse/toxic effect of Aminoglycosides. Specifically, an increased risk of nephrotoxicity may occur with the concomitant use of ataluren and aminoglycosides. Avoid combination
Bacitracin (Systemic): Kanamycin may enhance the nephrotoxic effect of Bacitracin (Systemic). Avoid combination
BCG (Intravesical): Antibiotics may diminish the therapeutic effect of BCG (Intravesical). Avoid combination
BCG Vaccine (Immunization): Antibiotics may diminish the therapeutic effect of BCG Vaccine (Immunization). Monitor therapy
Bisphosphonate Derivatives: Aminoglycosides may enhance the hypocalcemic effect of Bisphosphonate Derivatives. Monitor therapy
Capreomycin: May enhance the neuromuscular-blocking effect of Aminoglycosides. Monitor therapy
CARBOplatin: Aminoglycosides may enhance the ototoxic effect of CARBOplatin. Especially with higher doses of carboplatin. Monitor therapy
Cefazedone: May enhance the nephrotoxic effect of Aminoglycosides. Monitor therapy
Cephalosporins (2nd Generation): May enhance the nephrotoxic effect of Aminoglycosides. Monitor therapy
Cephalosporins (3rd Generation): May enhance the nephrotoxic effect of Aminoglycosides. Monitor therapy
Cephalosporins (4th Generation): May enhance the nephrotoxic effect of Aminoglycosides. Monitor therapy
Cephalothin: May enhance the nephrotoxic effect of Aminoglycosides. Monitor therapy
Cephradine: May enhance the nephrotoxic effect of Aminoglycosides. Monitor therapy
Cholera Vaccine: Antibiotics may diminish the therapeutic effect of Cholera Vaccine. Avoid combination
CISplatin: May enhance the nephrotoxic effect of Aminoglycosides. Monitor therapy
Colistimethate: Aminoglycosides may enhance the nephrotoxic effect of Colistimethate. Aminoglycosides may enhance the neuromuscular-blocking effect of Colistimethate. Consider therapy modification
CycloSPORINE (Systemic): Aminoglycosides may enhance the nephrotoxic effect of CycloSPORINE (Systemic). Monitor therapy
Distigmine: Aminoglycosides may diminish the therapeutic effect of Distigmine. Monitor therapy
Foscarnet: May enhance the nephrotoxic effect of Aminoglycosides. Avoid combination
Lactobacillus and Estriol: Antibiotics may diminish the therapeutic effect of Lactobacillus and Estriol. Monitor therapy
Loop Diuretics: May enhance the adverse/toxic effect of Aminoglycosides. Specifically, nephrotoxicity and ototoxicity. Monitor therapy
Mannitol (Systemic): May enhance the nephrotoxic effect of Aminoglycosides. Avoid combination
Mecamylamine: Aminoglycosides may enhance the neuromuscular-blocking effect of Mecamylamine. Avoid combination
Methoxyflurane: Aminoglycosides may enhance the nephrotoxic effect of Methoxyflurane. Avoid combination
Neuromuscular-Blocking Agents: Aminoglycosides may enhance the respiratory depressant effect of Neuromuscular-Blocking Agents. Monitor therapy
Nonsteroidal Anti-Inflammatory Agents: May decrease the excretion of Aminoglycosides. Data only in premature infants. Monitor therapy
OnabotulinumtoxinA: Aminoglycosides may enhance the neuromuscular-blocking effect of OnabotulinumtoxinA. Monitor therapy
Oxatomide: May enhance the ototoxic effect of Aminoglycosides. Monitor therapy
Penicillins: May decrease the serum concentration of Aminoglycosides. Primarily associated with extended spectrum penicillins, and patients with renal dysfunction. Exceptions: Amoxicillin; Ampicillin; Bacampicillin; Cloxacillin; Dicloxacillin; Nafcillin; Oxacillin; Penicillin G (Parenteral/Aqueous); Penicillin G Benzathine; Penicillin G Procaine; Penicillin V Benzathine; Penicillin V Potassium. Consider therapy modification
RimabotulinumtoxinB: Aminoglycosides may enhance the neuromuscular-blocking effect of RimabotulinumtoxinB. Monitor therapy
Sodium Picosulfate: Antibiotics may diminish the therapeutic effect of Sodium Picosulfate. Management: Consider using an alternative product for bowel cleansing prior to a colonoscopy in patients who have recently used or are concurrently using an antibiotic. Consider therapy modification
Tenofovir Products: Aminoglycosides may increase the serum concentration of Tenofovir Products. Tenofovir Products may increase the serum concentration of Aminoglycosides. Monitor therapy
Typhoid Vaccine: Antibiotics may diminish the therapeutic effect of Typhoid Vaccine. Only the live attenuated Ty21a strain is affected. Management: Vaccination with live attenuated typhoid vaccine (Ty21a) should be avoided in patients being treated with systemic antibacterial agents. Use of this vaccine should be postponed until at least 3 days after cessation of antibacterial agents. Consider therapy modification
Vancomycin: May enhance the nephrotoxic effect of Aminoglycosides. Monitor therapy
Some penicillin derivatives may accelerate the degradation of aminoglycosides in vitro, leading to a potential underestimation of aminoglycoside serum concentration.
Frequency not defined.
Central nervous system: Neurotoxicity, drowsiness, headache, pseudomotor cerebri
Dermatologic: Skin itching, redness, rash, photosensitivity, erythema
Gastrointestinal: Nausea, vomiting, diarrhea, malabsorption syndrome (with prolonged and high-dose therapy of hepatic coma), anorexia, weight loss, salivation increased, enterocolitis
Hematologic: Granulocytopenia, agranulocytosis, thrombocytopenia
Local: Burning, stinging
Neuromuscular & skeletal: Weakness, tremor, muscle cramps
Otic: Ototoxicity (auditory), ototoxicity (vestibular)
Concerns related to adverse effects:
• Nephrotoxicity: [U.S. Boxed Warning]: May cause nephrotoxicity; usual risk factors include pre-existing renal impairment, concomitant nephrotoxic medications, advanced age, and dehydration. Discontinue treatment if signs of nephrotoxicity occur; renal damage is usually reversible.
• Neuromuscular blockade and respiratory paralysis: May cause neuromuscular blockade and respiratory paralysis, especially when given soon after anesthesia or muscle relaxants.
• Neurotoxicity: [U.S. Boxed Warning]: May cause neurotoxicity; usual risk factors include pre-existing renal impairment, concomitant neuro-/nephrotoxic medications, advanced age, and dehydration. Ototoxicity is proportional to the amount of drug given and the duration of treatment. Tinnitus or vertigo may be indications of vestibular injury and impending bilateral irreversible damage. Discontinue treatment if signs of ototoxicity occur.
• Superinfection: Prolonged use may result in fungal or bacterial superinfection, including C. difficile-associated diarrhea (CDAD) and pseudomembranous colitis; CDAD has been observed >2 months postantibiotic treatment.
• Hearing impairment: Use with caution in patients with pre-existing vertigo, tinnitus, or hearing loss.
• Hypocalcemia: Use with caution in patients with hypocalcemia.
• Neuromuscular disorders: Use with caution in patients with neuromuscular disorders, including myasthenia gravis.
• Renal impairment: Use with caution in patients with pre-existing renal insufficiency; dosage modification required.
• Long-term use: Not intended for long-term therapy due to toxic hazards associated with extended administration.
Serum creatinine and BUN every 2-3 days; peak and trough concentrations; hearing
Some penicillin derivatives may accelerate the degradation of aminoglycosides in vitro. This may be clinically-significant for certain penicillin (ticarcillin, piperacillin, carbenicillin) and aminoglycoside (gentamicin, tobramycin) combination therapy in patients with significant renal impairment. Close monitoring of aminoglycoside levels is warranted.
Pregnancy Risk Factor
Kanamycin crosses the placenta. Aminoglycosides may cause fetal harm if administered to a pregnant woman. There are several reports of total irreversible bilateral congenital deafness in children whose mothers received another aminoglycoside (streptomycin) during pregnancy. Although serious side effects to the fetus/infant have not been reported following maternal use of all aminoglycosides, a potential for harm exists.
• Discuss specific use of drug and side effects with patient as it relates to treatment. (HCAHPS: During this hospital stay, were you given any medicine that you had not taken before? Before giving you any new medicine, how often did hospital staff tell you what the medicine was for? How often did hospital staff describe possible side effects in a way you could understand?)
• Have patient report immediately to prescriber signs of kidney problems (urinary retention, blood in urine, change in amount of urine passed, weight gain), change in balance, severe dizziness, passing out, hearing impairment, hearing loss, tinnitus, muscle weakness, burning or numbness feeling, twitching, seizures, shortness of breath, or loss of strength and energy (HCAHPS).
• Educate patient about signs of a significant reaction (eg, wheezing; chest tightness; fever; itching; bad cough; blue skin color; seizures; or swelling of face, lips, tongue, or throat). Note: This is not a comprehensive list of all side effects. Patient should consult prescriber for additional questions.
Intended Use and Disclaimer: Should not be printed and given to patients. This information is intended to serve as a concise initial reference for healthcare professionals to use when discussing medications with a patient. You must ultimately rely on your own discretion, experience and judgment in diagnosing, treating and advising patients.
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- Drug class: aminoglycosides
Other brands: Kantrex