Yes

Antibiotic, Aminoglycoside

Oral: Preoperative bowel preparation in the prophylaxis of infections and adjunctive treatment of hepatic coma (oral kanamycin is not indicated in the treatment of systemic infections); treatment of susceptible bacterial infection including gram-negative aerobes, gram-positive Bacillus as well as some mycobacteria

Parenteral: Rarely used in antibiotic irrigations during surgery

D

Hypersensitivity to kanamycin or any component or other aminoglycosides

Use with caution in patients with pre-existing renal insufficiency, vestibular or cochlear impairment, myasthenia gravis, conditions which depress neuromuscular transmission

Percentage unknown: Edema, neurotoxicity, drowsiness, headache, pseudomotor cerebri, skin itching, redness, rash, photosensitivity, erythema, nausea, vomiting, diarrhea (most common with oral form), malabsorption syndrome with prolonged and high-dose therapy of hepatic coma; anorexia, weight loss, increased salivation, enterocolitis, granulocytopenia, agranulocytosis, thrombocytopenia, burning, stinging, weakness, tremors, muscle cramps, ototoxicity (auditory), ototoxicity (vestibular), nephrotoxicity, dyspnea

Symptoms of overdose include ototoxicity, nephrotoxicity, and neuromuscular toxicity

The treatment of choice following a single acute overdose appears to be the maintenance of good urine output of at least 3 mL/kg/hour. Dialysis is of questionable value in the enhancement of aminoglycoside elimination. If required, hemodialysis is preferred over peritoneal dialysis in patients with normal renal function. Careful hydration may be all that is required to promote diuresis and, therefore, the enhancement of the drug's elimination.

Increased toxicity:

Penicillins, cephalosporins, amphotericin B, diuretics may increase nephrotoxicity; polypeptide antibiotics may increase risk of respiratory paralysis and renal dysfunction

Neuromuscular blocking agents with oral kanamycin may increase neuromuscular blockade; a small increase in warfarin's effect may occur due to decreased absorption of vitamin K

Decreased toxicity: Methotrexate with kanamycin (oral) may be less well absorbed as may digoxin (minor) and vitamin A

Darkening of vials does not indicate loss of potency

Interferes with protein synthesis in bacterial cell by binding to ribosomal subunit

Absorption: Oral: Not absorbed following administration

Relative diffusion of antimicrobial agents from blood into cerebrospinal fluid (CSF): Good only with inflammation (exceeds usual MICs)

Ratio of CSF to blood level (%): Normal meninges: Nil; Inflamed meninges: 43

Half-life: 2-4 hours, increases in anuria to 80 hours

End-stage renal disease: 40-96 hours

Time to peak serum concentration: I.M.: 1-2 hours

Elimination: Entirely in the kidney, principally by glomerular filtration

Children: Infections: I.M., I.V.: 15 mg/kg/day in divided doses every 8-12 hours

Adults:

Infections: I.M., I.V.: 5-7.5 mg/kg/dose in divided doses every 8-12 hours (<15 mg/kg/day)

Preoperative intestinal antisepsis: Oral: 1 g every 4-6 hours for 36-72 hours

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

Intraperitoneal: After contamination in surgery: 500 mg diluted in 20 mL distilled water; other irrigations: 0.25% solutions

Aerosol: 250 mg 2-4 times/day (250 mg diluted with 3 mL of NS and nebulized)

Dosing adjustment/interval in renal impairment:

Cl_cr 50-80 mL/minute: Administer 60% to 90% of dose or administer every 8-12 hours

Cl_cr 10-50 mL/minute: Administer 30% to 70% of dose or administer every 12 hours

Cl_cr <10 mL/minute: Administer 20% to 30% of dose or administer every 24-48 hours

Hemodialysis: Dialyzable (50% to 100%)

Serum creatinine and BUN every 2-3 days; peak and trough concentrations; hearing

Therapeutic: Peak: 25-35 mg/mL; Trough: 4-8 mg/mL; Toxic: Peak: >35 mg/mL; Trough: >10 mg/mL

May cause drowsiness or dizziness; case reports of delirium and psychosis with aminoglycosides

May cause agranulocytosis; use caution with clozapine and carbamazepine

No information available to require special precautions

No effects or complications reported

It is important to maintain adequate hydration (2-3 L/day of fluids unless instructed to restrict fluid intake). Report change in hearing acuity, ringing or roaring in ears, alteration in balance, vertigo, feeling of fullness in head; pain, tingling, or numbness of any body part; change in urinary pattern or decrease in urine; signs of opportunistic infection (eg, white plaques in mouth, vaginal discharge, unhealed sores, sore throat, unusual fever, chills); pain, redness, or swelling at injection site; skin rash; or other adverse reactions. Pregnancy precautions: Do not get pregnant during therapy with this medication; use appropriate barrier contraceptive measures.

Aminoglycoside levels in blood taken from Silastic® central catheters can sometime give falsely high readings. Administer around-the-clock rather than 4 times/day, 3 times/day, etc, (ie, 12-6-12-6, not 9-1-5-9) to promote less variation in peak and trough serum levels; modify dosage in patients with renal impairment; I.M. doses should be administered in a large muscle mass (ie, gluteus maximus).

Capsule, as sulfate: 500 mg

Injection, as sulfate:

Pediatric: 75 mg (2 mL)

Adults: 500 mg (2 mL); 1 g (3 mL)

Begg EJ and Barclay ML, "Aminoglycosides - 50 Years On," Br J Clin Pharmacol, 1995, 39(6):597-603.

Cunha BA, "Aminoglycosides: Current Role in Antimicrobial Therapy," Pharmacotherapy, 1988, 8(6):334-50.

"Drugs for Tuberculosis," Med Lett Drugs Ther, 1993, 35(908):99-101.

Iseman MD, "Treatment of Multidrug-Resistant Tuberculosis," N Engl J Med, 1993, 329(11):784-91.

Kristensen M, Molholm HJ, Kampmann J, et al, "Letter: Drug Elimination and Renal Function," J Clin Pharmacol, 1974, 14(5-6):307-8.

Yasuhara H, Kobayashi S, Sakamoto K, et al, "Pharmacokinetics of Amikacin and Cephalothin in Bedridden Elderly Patients," J Clin Pharmacol, 1982, 22:403-9.