Kanamycin Sulfate

 Action Inhibits production of bacterial protein, causing cell death.

 Indications

Parenteral: Short-term treatment of serious infections caused by susceptible strains of microorganisms, especially gram-negative bacteria. Oral: Short-term adjunctive therapy for suppression of intestinal bacteria; treatment of hepatic coma.

 Contraindications Hypersensitivity to aminoglycosides; intestinal obstruction (oral). Generally not indicated for long-term therapy (> 14 days) because of ototoxicity and nephrotoxicity.

 Route/Dosage

Infection

ADULTS & CHILDREN: IM/IV 15 mg/kg/day in 2–4 divided doses. Do not exceed 1.5 g/day.

Suppression of Intestinal Bacteria

Adults: PO 1 g qh for 4 hr, then 1 g q 6 hr for 36–72 hr.

Hepatic Coma

Adults: PO 8–12 g/day in divided doses.

 Interactions

Digoxin, methotrexate, vitamin A, vitamin K: Oral kanamycin may decrease absorption of these drugs. Beta-lactam antibiotics (eg, cephalosporins, penicillins): Do not mix in IV solutions. Drugs with nephrotoxic potential (eg, amphotericin, cephalosporins, enflurane, methoxyflurane, vancomycin): Increased risk of nephrotoxicity. Loop diuretics: Increased auditory toxicity. Neuromuscular blocking agents: Enhanced effects of these agents. Polypeptide antibiotics: Increased risk of respiratory paralysis and renal dysfunction.

 Lab Test Interferences None well documented.

 Adverse Reactions

CNS: Neuromuscular blockade. EENT: Hearing loss, deafness, loss of balance. GI: Malabsorption syndrome (eg, increased fecal fat, decreased serum carotene, fall in xylose absorption), nausea, vomiting, diarrhea. GU: Oliguria, proteinuria, elevated serum creatinine and BUN, granular casts, red and white cells in urine, decreased creatinine clearance. RESP: Apnea. OTHER: Pain and irritation at injection site, acute muscular paralysis; hypomagnesemia.

 Precautions

Pregnancy: Category D. Lactation: Excreted in breast milk. Children: Use cautiously in premature infants and neonates because of renal immaturity. Neuromuscular blockade: Use with caution in patients with neuromuscular disorders, those receiving anesthesia or muscle relaxants, hypomagnesemia, hypocalcemia, hypokalemia or in neonates whose mothers received magnesium sulfate. Oral absorption: Increased absorption (and potential for toxicity) when intestinal mucosa is ulcerated or denuded. Toxicity: Can cause ototoxicity, both auditory and vestibular. Nephrotoxicity may occur; greater risk factors in the elderly, patients with renal impairment, high or frequent doses, long duration of therapy, other nephrotoxic drugs, potassium depletion and decreased intravascular volume.

 Administration/Storage

• Do not mix with other antibacterial agents; administer separately.
• For IV administration, dilute each 500 mg with at least 100–200 ml of 0.9% Sodium Chloride or D5W. Give slowly over 30–60 min.
• Give IM injection deeply into upper outer quadrant of gluteal muscle.
• Store at room temperature. Darkening of vials during shelf life does not indicate loss of potency.

 Assessment/Interventions

• Obtain patient history, including drug history and any known allergies. Note hypersensitivity to aminoglycosides.
• Ensure that culture and sensitivity, renal function tests and serum electrolytes have been performed before beginning therapy and repeat periodically.
• Assess for superinfection (bacterial or fungal overgrowth).
• Assess for allergic-type reactions including anaphylactic symptoms and life-threatening or less severe asthmatic episodes in susceptible persons (more frequent in asthmatic or atopic nonasthmatic persons).
• Keep patient well hydrated (especially important in elderly).
• Assess auditory function regularly.
• Monitor drug serum concentrations periodically.
• Monitor I&O.

 Patient/Family Education

• Advise patient that drug may cause nausea, vomiting or diarrhea.
• Instruct patient to drink plenty of fluids while taking medication.
• Emphasize importance of follow-up visits and serial audiograms, because ototoxicity may be asymptomatic.
• Instruct patient to report these symptoms to physician: ringing in ears, hearing impairment, rash, difficulty urinating or dizziness.