KANAMYCIN

Kanamycin Pregnancy Warnings

There are no controlled data in human pregnancy. There are reports of fetal eighth cranial nerve toxicity and hearing loss after prolonged in utero exposure to kanamycin. If kanamycin is administered to a pregnant woman or a woman who becomes pregnant during therapy, she should be advised of the potential risk to the fetus. Kanamycin is only recommended for use during pregnancy when benefit outweighs risk.

Kanamycin Breastfeeding Warnings

Kanamycin is excreted into breast milk in small amounts (milk:plasma ratios of 0.05 to 0.4). Peak milk concentrations of 18.4 mcg/mL have been reported after administration of 1 g intramuscularly. The manufacturer recommends that because of the potential for serious adverse effects in nursing infants, a decision should be made to discontinue nursing or discontinue kanamycin, taking into account the importance of the drug to the mother. Kanamycin is considered compatible with breast-feeding by the American Academy of Pediatrics.

Minor side effects (if these symptoms persist or worsen, inform your doctor)

• Diarrhea, nausea or vomiting

Serious side effects (inform your doctor immediately)

• Loss of hearing, clumsiness, dizziness, greatly decreased frequency of urination or amount of urine, increased thirst, ringing or buzzing or a feeling of fullness in the ears, unsteadiness

• Inform your doctor
  • Allergy to the medication or any allergies

• May result in nephrotoxicity and ototoxicity espcially in those with with impaired renal function, those receiving high doses for prolonged periods of time, the elderly, and dehydrated patients. Tinnitus may be a indicative symptom of ototoxicity.

Aminoglycosides have also been associated with other signs of neurotoxicity including numbness, skin tingling, muscle twitching, and convulsions.

The concomitant or sequential use of other systemic or topical neurotoxic or nephrotoxic drugs (e.g., certain antineoplastics, potent diuretics, vancomycin, other aminoglycosides) should be avoided. The concomitant use of aminoglycosides and cephalosporins has reportedly resulted in increased nephrotoxicity.

Significant amounts of kanamycin may be absorbed if administered by irrigation or local application and may potentially cause neurotoxicity and nephrotoxicity.

Kanamycin serum concentrations should be monitored and the dosage adjusted to maintain adequate levels and to avoid prolonged excessive peak concentrations. Peak concentrations over 35 mcg/mL and trough levels over 10 mcg/mL should be avoided. Close monitoring of renal function is recommended, especially in elderly patients.

Aminoglycosides may aggravate muscle weakness due to their potential curare-like effects on neuromuscular function, therefore kanamycin should be used cautiously in patients with muscular disorders such as myasthenia gravis or Parkinson’s disease.

The possibility of neuromuscular blockade and respiratory paralysis exists if aminoglycosides are given to patients receiving anesthetics, neuromuscular blockers, or massive transfusions of citrate-anticoagulated blood. Calcium salts may reverse neuromuscular blockade if it occurs.

Paresthesias, tetany, mental confusion, muscle weakness, and positive Chvostek and Trousseau signs have been reported in hypomagnesemic, hypocalcemic, and hypokalemic patients during and after aminoglycosides treatment. Electrolyte levels should be monitored and corrected if necessary.

The sodium bisulfite preservative in some formulations of kanamycin may cause allergic, anaphylactic, or asthmatic reactions in sulfite-sensitive patients.

Patients should be well-hydrated during aminoglycoside treatment.

Aminoglycosides may cause fetal harm if administered during pregnancy.

Dosage

Applies to the following strength(s): 500 mg/2 mL ; 1 g/3 mL ; 500 mg ; 75 mg/2 mL

This information is not a substitute for medical advice. ALWAYS consult your doctor or pharmacist.

Usual Adult Dose for Bacterial Infection

Parenteral: 15 mg/kg/day IM or IV in divided doses every 8 to 12 hours

Duration: 7 to 10 days

Aerosol: 250 mg in 3 mL normal saline via nebulizer 2 to 4 times daily.

Irrigation: Kanamycin 2.5 mg/mL has been used for the irrigation of peritoneal and ventricular cavities, abscess cavities, and pleural space.

Maximum dose: The maximum recommended dose by all routes is 1.5 g/day. Serum levels should be monitored during treatment. Peak concentrations >35 mcg/mL and trough levels >10 mcg/mL should be avoided.

Usual Adult Dose for Peritonitis

Intraperitoneal, postsurgical: 500 mg in 20 mL sterile distilled water instilled into the wound at closure.

Maximum dose: The maximum recommended dose by all routes is 1.5 g/day. Serum levels should be monitored during treatment. Peak concentrations >35 mcg/mL and trough levels >10 mcg/mL should be avoided.

Usual Adult Dose for Tuberculosis – Active

15 mg/kg (maximum 1 g) IM or IV every 24 hours.

Should be given in combination with at least 3 other active drugs for treatment of multi-drug resistant TB, or when the patient is intolerant of first-line agents. AFB smear and culture should be monitored monthly.

Duration: Treatment for TB should generally continue for 18 to 24 months, or for 12 to 18 months after culture results are negative. Because of its toxicity, kanamycin is not indicated for long-term therapy.

Usual Pediatric Dose for Bacterial Infection

<7 days:

<2 kg: 15 mg/kg/day in divided doses every 12 hours.

>=2 kg: 15 to 20 mg/kg/day in divided doses every 12 hours.

>=7 days:

<2 kg: 15 to 22.5 mg/kg/day in divided doses every 8 hours.

>=2 kg: 15 to 30 mg/kg/day in divided doses every 8 hours.

>=1 month: 15 to 30 mg/kg/day in divided doses every 8 to 12 hours.

Usual Pediatric Dose for Tuberculosis – Active

15 to 30 mg/kg (maximum 1 g) IM or IV every 24 hours.

Should be given in combination with at least 3 other active drugs for treatment of multi-drug resistant TB, or when the patient is intolerant of first-line agents. AFB smear and culture should be monitored monthly.

Duration: Treatment for TB should generally continue for 18 to 24 months, or for 12 to 18 months after culture results are negative. Because of its toxicity, kanamycin is not indicated for long-term therapy.

Renal Dose Adjustments

Dosage should be adjusted in renal insufficiency. Various nomograms and methods have been proposed for determining the dosage in renally impaired patients – reduced doses at fixed intervals or normal doses at prolonged intervals. Regimens are ideally based on individualized pharmacokinetic dosing.

Adults:

The following adjustments to the maintenance dose have been suggested (modified from Sarubbi and Hull, 1978):

CrCl 70 to 80 mL/min: 76 to 91% of the loading dose every 8 to 12 hours

CrCl 60 to 70 mL/min: 71 to 88% of the loading dose every 8 to 12 hours

CrCl 50 to 60 mL/min: 65 to 84% of the loading dose every 8 to 12 hours

CrCl 40 to 50 mL/min: 72 to 92% of the loading dose every 12 to 24 hours

CrCl 30 to 40 mL/min: 63 to 92% of the loading dose every 12 to 24 hours

CrCl 20 to 30 mL/min: 50 to 81% of the loading dose every 12 to 24 hours

CrCl 10 to 20 mL/min: 34 to 75% of the loading dose every 12 to 24 hours

CrCl<10 mL/min: 21 to 47% of the loading dose every 24 hours or a onetime loading dose with subsequent doses based on serum concentrations, estimated clearance and the patient’s condition.

The manufacturer recommends interval prolongation based on the serum creatinine (in mg/dL) multiplied by 9.

Liver Dose Adjustments

No adjustment recommended

Dialysis

Hemodialysis and peritoneal dialysis: Onetime loading dose, with subsequent doses based on serum concentrations, estimated clearance and the patient’s condition.

Brands

Also marketed as

• Kanamycin Meiji [ Meiji Seika ]