kanamycin [IM/IV]

Adult Dosing

Bacterial infections

7.5 mg/kg IM/IV q12 hrs
Alt: 5 mg/kg IM/IV q8 hrs; Max: 1.5 g/day
The patient's pre treatment or ideal body weight should be obtained for calculation of the correct dosage

Pediatric Dosing

Bacterial infections

7.5 mg/kg IM/IV q12 hrs
Alt: 5 mg/kg IM/IV q8 hrs; Max: 1.5 g/day
The patient's pre treatment body weight should be obtained for calculation of the correct dosage

[Outline]

Adult Dosing
Pediatric Dosing

Indications ⬆ ⬇

Treatment of serious bacterial infections when other less toxic drugs are contraindicated

Contraindications ⬆ ⬇

Hypersensitivity to any of the ingredients of the product

Black Box Warnings ⬆ ⬇

Kanamycin can cause severe neurotoxicity, irreversible ototoxicity and nephrotoxicity
Risk increases with renal impairment or pre-renal azotemia, high dose, prolonged therapy
Ototoxicity is usually irreversible
Monitor audiograms in high risk patients. Discontinue or decrease dose if ototoxicity. Avoid concurrent and/or sequential neurotoxic agents; avoid concurrent potent diuretics
Neurotoxicity may manifest in the form of disturbances of vestibular and cochlear function, peripheral neuritis, arachnoiditis, encephalopathy, vertigo, numbness, tingling, muscle twitching, convulsions
Kanamycin causes nephrotoxicity; increased risk with renal impairment, high dose, prolonged use
Monitor renal function, peak/trough levels. Discontinue or decrease dose if nephrotoxicity is seen
Avoid concurrent and/or sequential nephrotoxic agents. Avoid concurrent potent diuretics
Neuromuscular blockade including respiratory paralysis can occur especially if given soon after anesthesia or after use of neuromuscular blockers, muscle relaxants

Dosing Adjustment ⬆ ⬇

Renal Dose Adjustment (Based on CrCl)

50 mL/min: Give q12-24 hrs
10-50 mL/min: Give q24-72 hrs
<10 mL/min: Give q48-72 hrs

Hepatic Dose Adjustment

Hepatic impairment: Dose adjustments not defined

Warnings/Precautions ⬆ ⬇

Kanamycin can cause severe neurotoxicity and ototoxicity. The degree of impairment of vestibular and auditory function is proportional to the dose and duration of therapy, age of the patient, level of renal function and underlying existing auditory dysfunction [US Black Box Warning]
Select dosage regimen carefully in patients with renal impairment. Risk of ototoxicity and neurotoxicity increases with renal impairment [US Black Box Warning]
Do not exceed recommended dosage
Kanamycin can cause fetal harm if administered to a pregnant woman. It crosses placental barrier and may cause ototoxicity in the fetus
Monitor BUN/Cr at baseline, then periodically
Monitor serum drug levels; urinalysis; audiometry for high risk patients or if prolonged therapy or if symptoms of hearing impairment

Cautions: Use cautiously in

Renal impairment
Neuromuscular disease
Impaired vestibular function
Impaired auditory function
Concurrent ototoxic agents
Concurrent neurotoxic agents
Dehydration
Concurrent nephrotoxic agents
Electrolyte abnormalities
Prolonged use
Obese patients
Neonates/infants
Elderly pts

Pregnancy/Breast Feeding ⬆ ⬇

Pregnancy Category:D

Breastfeeding: Probably safe. If kanamycin is required by the mother, it is not a reason to discontinue breastfeeding. Kanamycin is poorly excreted into breastmilk. This information is based upon LactMed database (available at http://toxnet.nlm.nih.gov/cgi-bin/sis/htmlgen?LACT last accessed 7 April 2011). This drug is compatible and considered safe with breastfeeding based upon data from AAP Policy Guidelines (available at http://aappolicy.aappublications.org/cgi/content/full/pediatrics;108/3/776 last accessed 7 April 2011). Due to the potential for serious adverse reactions in nursing infants, manufacturer recommends discontinuation of nursing or discontinuation of drug, taking into account the importance of the drug to the mother

Adverse Reactions ⬆ ⬇

EENT: Vestibular ototoxicity (nausea, vomiting, vertigo), cochlear ototoxicity (deafness), hearing loss, tinnitus, vertigo
CNS: Neurotoxicity, neuromuscular blockade
GU: Azotemia, nephrotoxicity
DERM: Rash, urticaria, exfoliative dermatitis
METABOLIC: Elevated BUN, Cr
MUSC: Muscle paralysis
LOCAL: Injection site reaction
MISC: Hypersensitivity reactions, superinfection

Clinical Pharmacology ⬆ ⬇

Aminoglycoside; binds to 30S ribosome and inhibits bacterial protein synthesis
Well absorbed after IM administration. IV administration results in complete bioavailability
Metabolism: Unknown
Excreted unchanged in urine
Half-life: 2.5 hrs

Brands and Availability ⬆ ⬇