Kanamycin

These indications are based on manufacturer information for both originator and generic products. For product specific registered indications, please refer to product specific manufacturer information

Registered South African indications:

• Respiratory tract infections due to staphylococcus, pneumococcus, Streptococcus viridans and Hemophilus influenzae, pharyngitis, bronchitis, tonsillitis, bronchopneumonia, pneumonia etc
• Urinary tract infections due to staphylococcus, Escherichia coli, Pseudomonas aeruginosa and Proteus vulgaris, acute and chronic cystitis, acute pyelitis, urethritis etc
• Gonococcal infections, acute and chronic urethritis, S. epididymitis, cystitis, cervicitis etc
• Suppurative infections due to staphylococcus, pneumococcus and Pseudomonas aeruginosa, impetigo, phlegmon, lymphadenitis, abscess, mastitis, otitis media, osteomyelitis, carbuncle, post-operative infections etc
• Adnexitis
• Prophylactic use for post-operative infections
• Pulmonary tuberculosis, urinary tuberculosis, genital tuberculosis, tuberculosis of the nymph node, bone and joint tuberculosis

Contraindications

• Hypersensitivity to the active ingredient or any of its excipients

Cautions

• Pregnancy
• Breastfeeding
• Renal impairment
• Elderly
• Porphyria
• Pre-existing hearing impairment
• Myasthenia gravis
• Parkinsonism
• Conditions characterised by muscle weakness
• Renal impairment
• Elderly
• Hypocalcaemia
• Dehydration
• Prolonged use
• History of vertigo
• History of tinnitis

Forms avail. in SA and covered in this monograph: inj

Infections caused by: Mycobacterium tuberculosis; Gram-negative aerobic bacilli (excluding Serratia sp and P. aeruginosa)

General dosing range

• IM/IV: 15mg/kg, dly or in 2-3 divided doses; Max: 1.5g/24hrs; Max total dosage over entire treatment course: 15g

Specific doses based on individual indications

Please note that the dosages below should be used in combination with regional guidelines, taking into account local antibiotic sensitivities

Pre-extremely drug resistant tuberculosis (XDR TB)
XDR-TB second line

• <50kg: IM: 500-750mg, dly; Treatment duration: 6-8 months
• >50kg: IM: 1g, dly; Treatment duration: 6-8 months
  Refer to TB clinical guide South Africa

Not commonly used for children in South Africa 

Pregnancy

• Caution
• Aminoglycosides have the potential to cause foetal harm if administered to pregnant woman, kanamycin crosses the placenta. Reports have been made of bilateral congenital deafness in children whose mothers received streptomycin during pregnancy. There are currently no  reports on serious side effects to the foetus/ infant after maternal use of all aminoglycosides, however a potential for harm exists

Breastfeeding

• Caution; not recommended
• Kanamycin is excreted into breast milk. A decision has to be made on whether to discontinue breastfeeding or give an alternate agent due to the potential risk for serious adverse reactions in the nursing infant. Aminoglycosides are generally expected to be poorly distributed into breast milk, thereby limiting exposure to the nursing infant

Renal Impairment

• Caution; dose adjustment recommended

*For continuous renal replacement therapy (CRRT) (see additional prescribing points)

Hepatic Impairment

• No dose adjustment recommended

Elderly

• Caution; dose adjustment recommended
  Initial: 5-7.5mg/kg; Dose interval: 12-24hrly; Maintenance: Based on estimated renal function

Porphyria Information

• Not yet classified (NC)

Drugs in Sport

• Permitted - No warnings

Central Nervous System Disorders

• Neurotoxicity
• Muscle twitching
• Numbness
• Seizures
• Tingling
• Neuromuscular block
• Encephalopathy
• Confusion
• Lethargy
• Hallucinations
• Convulsions
• Mental depression

Gastrointestinal Disorders

• Nausea and vomiting
• Loss of appetite
• Stomatitis
• Diarrhoea
• Staphylococcal enterocolitis
• Malabsorption syndrome

Hepatobiliary Disorders

• Hepatic impairment
• Increased serum amino transferase values
• Increased serum bilirubin concentrations

Genitourinary Disorders

• Nephrotoxicity

Skin and Subcutaneous Tissue Disorders

• Injection site pain
• Injection site bruising
• Injection site haematoma

Immune, Blood and Lymphatic System Disorders

• Blood dyscrasias
• Purpura
• Hypersensitivity reactions
• Anaphylaxis
• Fever

Sensory Disorders

• Loss of hearing
• Ringing 
• Buzzing
• Feeling of fullness in the ears
• Vestibular effects 

• Halogenated hydrocarbon inhalation anaesthetic agents
• Muscle relaxants
• Nephrotoxic agents
• Ototoxic agents
• Opioid analgaesics
• Methoxyflurance
• Parenteral polymixins
• Anticoagulants
• Antiemetics
• Neurotoxic agents
• Neuromuscular blocking agents
• Amphoteracin B
• BCG vaccine
• Bisphosphonate derivative
• Botulinum toxin A
• Capreomycin
• Carboplatin
• Cephalosporin
• Cisplatin
• Cyclosporin
• Foscarnet
• Loop diuretics
• Mannitol
• Tenofovir
• Vancomycin

• Audiometry
• Renal function
• Electrolytes

Injection 1g/3ml - EML (Hospital)

Renal Adjustment in Continuous renal replacement therapy (CRRT):

• Administer every 24-72 hrs; Monitor levels
• Drug clearance is 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 necessary)

Kanamycin is a bactericidal agent. It acts by binding to the aminoacyl site of 16S ribosomal RNA within the 30S ribosomal subunit which causes misreading of the messenger RNA. This results in an incorrect amino acid being inserted into polypeptides which renders them non-functional or toxic to the cell.

Infections caused by: Mycobacterium tuberculosis; Gram-negative aerobic bacilli (excluding Serratia spp and P. aeruginosa)

Injection (per 3ml) 1g

• Kanamycin 1g Biotech (Biotech)
• Bio-Kanamycin (Biotech)