KANAMYCIN

Indications & Dose:

Severe systemic infections of CNS, respiratory, GI, urinary tract, bone, skin, soft tissues caused by susceptible organisms; Mycobacterium avium complex infections (as part of a multiple-drug regimen),* cystic fibrosis (inhaled), suppression of intestinal bacteria (PO), hepatic coma (PQ) 

DOSE

Adult

• Severe systemic infections: IM/IV 15 mg/kg/day divided q8-12h; do not exceed 1.5 g/day

• Suppression of intestinal bacteria: PO 1 g q 1h for 4hr, followed by 1 g q6h for 36-72 hr

• Hepatic coma: PO 8-12 g/day in divided doses

• Aerosol treatment: 250 mg bidqid; withdraw 250 mg (1 ml) from 500 mg vial, dilute with 3 ml normal saline, and nebulize

• Intraperitoneal: 500 mg diluted in 20 ml sterile distilled water instilled through a polyethylene catheter into wound (absorption similar to IM use)

Child

• Severe systemic infections: IM/IV 15 mg/kg/ day divided q8-12h; do not exceed 1.5 g/day

Contraindications:

Hypersensitivity to aminoglycosides.

Side Effects:

CNS: Headache, neuromuscular blockade, paresthesia

EENT: Deafness, hearing loss, loss of balance, ototoxicity

GI: Diarrhea, nausea, vomiting

GU: Azotemia, hematuria, nephrotoxicity, oliguria, renal failure

MS: Acute muscular paralysis

RESP: Apnea

SKIN: Rash 

Cautions:

Precautions:

Neonates, renal disease, myasthenia gravis, hearing deficits, Parkinson’s disease, elderly, dehydration 

Interaction:

Drugs

Amphotericin B: Synergistic nephrotoxicity

Atracurium: Kanamycin potentiates respiratory depression by atracurium

Carbenicillin: Potential for inactivation of kanamycin in patients with renal failure

Carboplatin: Additive nephrotoxicity or ototoxicity

Cephalosporins: Increased potential for nephrotoxicity in patients with preexisting renal disease

Cisplatin: Additive nephrotoxicity or ototoxicity

Cyclosporine: Additive nephrotoxicity

Ethacrynic acid: Additive ototoxicity

Indomethacin: Reduced renal clearance of kanamycin in premature infants

Methoxyflurane: Additive nephrotoxicity

Neuromuscular blocking agents:Kanamycin potentiates respiratory depression by neuromuscular blocking agents

NSAIDs: May reduce renal clearance of kanamycin

Penicillins (extended spectrum): Potential for inactivation of kanamycin in patients with renal failure

Piperacillin: Potential for inactivation of kanamycin in patients with renal failure

Succinylcholine: Kanamycin potentiates respiratory depression by succinylcholine

Ticarcillin: Potential for inactivation of kanamycin in patients with renal failure

Vancomycin: Additive nephrotoxicity or ototoxicity

Vecuronium: Kanamycin potentiates respiratory depression by vecuronium 

Warnings:

Adverse Effects:

Lactations:

Excreted into breast milk in low concentrations; poor oral Brands Available with Cost reduces potential for ototoxicity for the infant; compatible with breast feeding 

Special Precautions:

Counselling:

Side Effects Or Adverse Reactions:

Patient And Carer Advice: