📋 Clinical Overview

Kanamycin is a bactericidal aminoglycoside antibiotic derived from *Streptomyces kanamyceticus*. It is primarily used for the treatment of serious infections caused by susceptible aerobic gram-negative bacteria and mycobacteria, particularly in the context of multidrug-resistant tuberculosis (MDR-TB) in India. Its use is limited by significant ototoxicity and nephrotoxicity, requiring careful monitoring.

💊 Dosage & Administration

Adult: For MDR-TB (IM): 15 mg/kg (typically 750mg to 1000mg) once daily or 5 days per week. Maximum single dose should not exceed 1 gram. For systemic infections (IM/IV): 15 mg/kg/day in divided doses every 8-12 hours.

Note: Administered as a deep intramuscular injection into a large muscle mass (gluteal or lateral thigh). Rotate injection sites. For IV use, it must be diluted and infused over 30-60 minutes. Oral formulation is not absorbed and used only for gut sterilization.

⚠️ Contraindications

History of hypersensitivity to kanamycin or other aminoglycosides
Pre-existing severe auditory or vestibular impairment (relative, often considered absolute for long-term use)
Concurrent use of other ototoxic or nephrotoxic drugs (e.g., potent diuretics like furosemide)

🔬 Mechanism of Action

Kanamycin binds irreversibly to the 30S ribosomal subunit of susceptible bacteria. This binding interferes with the initiation complex, misreads the mRNA code, and causes premature termination of protein synthesis. The result is bactericidal activity against actively dividing organisms.

🤕 Side Effects

Pain, induration, or sterile abscess at injection site
Mild proteinuria, presence of casts in urine

🤰 Special Populations

Pregnancy: Category D (US FDA). Demonstrated fetal risk (ototoxicity). Use only if the potential benefit justifies the potential risk to the fetus, primarily in life-threatening MDR-TB. Adequate counseling required.

Driving: Patients should be cautioned that dizziness, vertigo, or tinnitus may impair the ability to drive or operate machinery.

🔄 Drug Interactions

Furosemide / Ethacrynic Acid	Potentiates ototoxicity (additive damage to hair cells)	Major
Other Aminoglycosides (Gentamicin, Amikacin)	Increased risk of nephrotoxicity and ototoxicity	Major
Vancomycin	Increased risk of nephrotoxicity	Major
Cisplatin	Additive ototoxicity and nephrotoxicity	Major
Neuromuscular blocking agents (e.g., Succinylcholine)	Enhanced and prolonged neuromuscular blockade, risk of respiratory arrest	Major
Penicillins (e.g., Carbenicillin, Ticarcillin)	Physical inactivation of kanamycin if mixed in same IV line; may also have synergistic antibacterial effect in vivo.	Moderate

KANABIOTIC