Kanamycin- IV

• Severe Infections:
• Pneumonia:  Adult dosage strength can range from 15 to 25 mg/kg/day, divided into 2 to 3 equally spaced doses.
• Sepsis:  Adult dosage strength can range from 15 to 25 mg/kg/day, divided into 2 to 3 equally spaced doses.
• Urinary Tract Infections:  Adult dosage strength can range from 15 to 25 mg/kg/day, divided into 2 to 3 equally spaced doses.
• Intra-abdominal Infections:  Adult dosage strength can range from 15 to 25 mg/kg/day, divided into 2 to 3 equally spaced doses.
• Endocarditis:
• Native Valve Endocarditis:  Adult dosage strength can range from 15 to 25 mg/kg/day, divided into 2 to 3 equally spaced doses.
• Prosthetic Valve Endocarditis:  Adult dosage strength can range from 25 to 35 mg/kg/day, divided into 2 to 3 equally spaced doses.

Injectables

• Dosage Adjustments in Kidney Patients:

There are no specific dietary restrictions related to the use of kanamycin. However, it is generally recommended to follow a balanced and healthy diet while undergoing treatment with any medication, including kanamycin. Eating a nutritious diet can support overall health and aid in the recovery process.

It is important to maintain adequate hydration during treatment with kanamycin and in general. Drinking an adequate amount of water and fluids can help support kidney function and prevent dehydration.

Patients with a known allergy to Kanamycin- IV or any of its components should avoid using Kanamycin- IV Sulfate Injection USP. Additionally, if a patient has a history of hypersensitivity or serious toxic reactions to aminoglycosides, it may also be contraindicated to use any other aminoglycoside due to the possibility of cross-sensitivities that can occur within this class of drugs.

1. Patients receiving aminoglycoside treatment, including kanamycin sulfate, should be closely monitored due to the potential for toxicity associated with these medications. The major toxic effects of kanamycin sulfate are its impact on the auditory and vestibular branches of the eighth nerve, as well as the renal tubules. Neurotoxicity can be observed through permanent bilateral auditory toxicity and sometimes vestibular ototoxicity. Audiometric testing can detect loss of high-frequency perception even before clinical hearing loss becomes noticeable. Cochlear damage may develop without clinical symptoms. Vestibular injury may manifest as vertigo. Other signs of neurotoxicity include numbness, skin tingling, muscle twitching, and convulsions. The risk of hearing loss increases with exposure to high peak or trough serum concentrations and can continue to progress even after discontinuing the drug.
2. Renal impairment may be indicated by reduced creatinine clearance, presence of cells or casts, oliguria, proteinuria, decreased urine specific gravity, or evidence of increasing nitrogen retention (increasing BUN, NPN, or serum creatinine). Patients with impaired renal function or those receiving high doses or prolonged therapy are at higher risk of severe ototoxic and nephrotoxic reactions. Close monitoring of renal and eighth nerve function is necessary, especially in patients with known or suspected reduced renal function at the start of therapy and in those who develop signs of renal dysfunction during treatment. Serum concentrations of parenterally administered aminoglycosides should be monitored when possible to ensure adequate levels and prevent potential toxicity. Urine should be examined for changes such as decreased specific gravity, increased protein excretion, and the presence of cells or casts. Periodic measurements of blood urea nitrogen, serum creatinine, or creatinine clearance are recommended. Serial audiograms should be obtained in patients old enough to be tested, particularly those at high risk. Dosage adjustment or discontinuation of the drug is necessary if evidence of ototoxicity (dizziness, vertigo, tinnitus, roaring in the ears, and hearing loss) or nephrotoxicity is observed. In the presence of anesthesia and muscle-relaxing drugs, intraperitoneal instillation of kanamycin sulfate may lead to neuromuscular blockade with respiratory paralysis. Neuromuscular blockade and respiratory paralysis have been reported with parenteral injection and oral use of aminoglycosides. Caution should be exercised when administering aminoglycosides, especially in patients receiving anesthetics, neuromuscular-blocking agents, or massive transfusions of citrate-anticoagulated blood. Calcium salts may reduce these effects, but mechanical respiratory assistance may be required.
3. Concurrent or sequential use of kanamycin and other potentially nephrotoxic or neurotoxic drugs, including polymyxin B, bacitracin, colistin, amphotericin B, cisplatin, vancomycin, and other aminoglycosides, should be avoided due to the potential for additive toxicity. Advanced age and dehydration also increase the patient's risk of toxicity. Kanamycin sulfate should not be administered simultaneously with potent diuretics (ethacrynic acid, furosemide, meralluride sodium, sodium mercaptomerin, or mannitol) as some diuretics themselves can cause ototoxicity and intravenously administered diuretics may alter antibiotic concentrations in serum and tissues, potentially enhancing aminoglycoside toxicity.

There is no specific alcohol warning for kanamycin IV. However, it is generally advisable to avoid consuming alcohol while undergoing treatment with any medication, including kanamycin. Alcohol can have various effects on the body and may interact with medications, potentially leading to adverse reactions or reducing the effectiveness of the treatment.

Additionally, alcohol can strain the liver and kidneys, which are organs involved in the elimination of medications from the body. Since kanamycin can have potential side effects on these organs, alcohol consumption may exacerbate these effects.

Aminoglycosides have the potential to cause harm to the fetus when administered to pregnant women. These antibiotics can cross the placenta, and there have been reports of permanent, bilateral congenital deafness in children whose mothers received streptomycin during pregnancy. While no serious side effects to the fetus or newborn have been specifically reported with other aminoglycosides used in the treatment of pregnant women, there is still a possibility of harm.

Reproductive studies conducted on rats and rabbits have not shown any evidence of impaired fertility or teratogenic effects (causing birth defects). However, when pregnant rats and guinea pigs were given dosages of 200 mg/kg/day, it resulted in hearing impairment in their offspring. Although there are no well-controlled studies in pregnant women, the clinical experience thus far does not provide positive evidence of adverse effects on the fetus. Nevertheless, it is important to inform pregnant patients about the potential risks to the fetus if the drug is used during pregnancy or if the patient becomes pregnant while taking the medication.

There are no specific food warnings related to the use of kanamycin IV. However, it is generally recommended to follow a balanced and healthy diet while undergoing treatment with any medication, including kanamycin. Eating a nutritious diet can support overall health and aid in the recovery process.

• Nausea/vomiting
• Diarrhea
• Injection site reactions (e.g., pain, redness, inflammation)
• Transient kidney function abnormalities (e.g., increased blood urea nitrogen, creatinine levels)

• Dizziness
• Headache
• Rash or skin reactions
• Allergic reactions (e.g., itching, swelling, difficulty breathing)
• Tinnitus (ringing in the ears)
• Neurotoxicity (e.g., numbness, tingling, muscle weakness)
• Blood disorders (e.g., anemia, leukopenia, thrombocytopenia)
• Electrolyte imbalances (e.g., low potassium or magnesium levels)

• Irreversible hearing loss (particularly at higher doses or with prolonged use)
• Vestibular toxicity (affecting balance and coordination)
• Visual disturbances
• Seizures
• Liver function abnormalities
• Respiratory distress or difficulty breathing

1. Other ototoxic drugs: Concurrent use of kanamycin with other medications known to cause hearing loss or damage to the auditory system, such as loop diuretics or certain chemotherapy drugs, may increase the risk of hearing loss.
2. Nephrotoxic drugs: Combining kanamycin with other nephrotoxic drugs, such as nonsteroidal anti-inflammatory drugs (NSAIDs), certain antibiotics (e.g., vancomycin), or contrast agents used in imaging procedures, may enhance the risk of kidney toxicity.
3. Neuromuscular blockers: The use of kanamycin with neuromuscular blocking agents, commonly used during surgeries, can potentiate the muscle-relaxing effects of these drugs, leading to prolonged muscle paralysis.
4. Diuretics: Certain diuretics, such as furosemide, when used concurrently with kanamycin, may increase the risk of kidney damage or hearing loss.
5. Interactions with other antibiotics: Some antibiotics, such as penicillins or cephalosporins, can interfere with the effectiveness of kanamycin. Combination therapy with these drugs may require careful monitoring and adjustment of dosages.
6. Interactions with neuromuscular blocking monitoring: Kanamycin administration can affect neuromuscular function monitoring tests, potentially leading to inaccurate results.

● Kidney toxicity

● Hearing loss

● Balance issues

● Nausea/vomiting

● Diarrhea

● Allergic reactions

● Neurotoxicity

● Blood disorders

● Injection site reactions

Aminoglycosides have the potential to cause harm to the fetus when administered to pregnant women. These antibiotics can cross the placenta, and there have been reports of permanent, bilateral congenital deafness in children whose mothers received streptomycin during pregnancy. While no serious side effects to the fetus or newborn have been specifically reported with other aminoglycosides used in the treatment of pregnant women, there is still a possibility of harm.

Reproductive studies conducted on rats and rabbits have not shown any evidence of impaired fertility or teratogenic effects (causing birth defects). However, when pregnant rats and guinea pigs were given dosages of 200 mg/kg/day, it resulted in hearing impairment in their offspring. Although there are no well-controlled studies in pregnant women, the clinical experience thus far does not provide positive evidence of adverse effects on the fetus. Nevertheless, it is important to inform pregnant patients about the potential risks to the fetus if the drug is used during pregnancy or if the patient becomes pregnant while taking the medication.

In the case of an overdose of kanamycin, it is important to seek immediate medical attention. Overdosing on kanamycin can lead to severe adverse effects and toxicity.

Treatment for kanamycin overdose typically involves supportive measures to manage the symptoms and minimize the drug's harmful effects. These measures may include:

1. Monitoring and supportive care: Close monitoring of vital signs, such as heart rate, blood pressure, and respiratory rate, is essential. Supportive care, including maintaining hydration and electrolyte balance, may be necessary.
2. Gastric decontamination: If the overdose is recent, gastric lavage (stomach pumping) or administration of activated charcoal may be considered to reduce further absorption of the drug from the gastrointestinal tract.
3. Symptomatic treatment: Symptoms and complications arising from the overdose, such as kidney damage or hearing loss, will be addressed as appropriate. Medications or interventions may be provided to manage specific symptoms or complications.
4. Hemodialysis: In severe cases, hemodialysis, a process that filters the blood to remove toxins, may be employed to enhance the elimination of kanamycin from the body.

Kanamycin belongs to the class of aminoglycoside antibiotics. These antibiotics exert their action by binding to the bacterial 30S ribosomal subunit. This binding interferes with the accurate reading of t-RNA, leading to an inability of the bacterium to synthesize essential proteins required for its growth. Aminoglycosides are primarily effective against aerobic, Gram-negative bacteria such as Pseudomonas, Acinetobacter, and Enterobacter. They also exhibit susceptibility against certain mycobacteria, including the ones responsible for tuberculosis.

While aminoglycosides can be used to treat infections caused by Gram-positive bacteria, other types of antibiotics are generally more potent and cause less harm to the host. In the past, aminoglycosides have been utilized in combination with penicillin-related antibiotics for their synergistic effects, particularly in the treatment of streptococcal infections, including endocarditis. However, aminoglycosides are generally ineffective against anaerobic bacteria, fungi, and viruses.

● Absorption and Serum Levels after Intramuscular Injection:

The drug rapidly enters the bloodstream after being administered through intramuscular injection. Typically, peak serum levels are achieved within approximately one hour. Administering a dose of 7.5 mg/kg results in mean peak levels of 22 µg/mL.

● Serum Levels over Time:

After 8 hours following a 7.5 mg/kg dose, the mean serum levels drop to 3.2 µg/mL. The drug has a serum half-life of 2½ hours.

● Comparison of Intravenous and Intramuscular Administration:

When kanamycin is given intravenously over a period of one hour, the resulting serum concentrations are similar to those obtained through intramuscular administration.

● Distribution in Body Fluids:

Kanamycin readily diffuses into various body fluids, including synovial and peritoneal fluids and bile. Notably, significant levels of the drug can be detected in cord blood and amniotic fluid after intramuscular administration to pregnant patients.

● Kanamycin in Spinal Fluid:

In normal infants, spinal fluid concentrations of kanamycin are approximately 10 to 20 percent of serum levels. However, when the meninges are inflamed, the spinal fluid concentration may reach up to 50 percent.

● Kanamycin in Adults:

Studies conducted in normal adult patients show only trace levels of kanamycin in spinal fluid. Unfortunately, there is no available data on adults with meningitis regarding the drug's presence in spinal fluid.

● Renal Excretion:

Kanamycin is primarily excreted through glomerular filtration in the kidneys and is not reabsorbed by the renal tubules. Consequently, high concentrations of the drug accumulate in the nephron, leading to urine levels 10 to 20 times higher than serum levels. The drug undergoes minimal metabolic transformation.

● Renal Excretion Rates:

In patients with normal renal function, approximately half of the administered dose is cleared within 4 hours. Complete excretion occurs within 24 to 48 hours. However, individuals with impaired renal function or diminished glomerular filtration pressure eliminate kanamycin at a slower rate, potentially resulting in excessively high blood levels and an increased risk of ototoxic reactions.

● Effects in Severely Burned Patients:

In severely burned patients, the half-life of kanamycin may be significantly decreased. Consequently, serum concentrations of the drug may be lower than anticipated based on the milligrams per kilogram dose.