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, necessitating strict therapeutic drug monitoring (TDM).
Adult: For systemic infections: 15 mg/kg/day in 2 divided doses IM/IV. For MDR-TB (as per NTEP guidelines): 15 mg/kg/day (max 1 gm/day) IM, typically 5-7 days/week. The total daily dose should not exceed 1.5 gm.
Note: For IM use: Deep intramuscular injection into a large muscle mass (gluteus). For IV use: Dilute in 50-100 mL of compatible IV fluid (NS or D5W) and infuse over 30-60 minutes. NEVER give IV push. Rotate injection sites. Monitor peak (1 hour post-dose) and trough (just before next dose) serum levels.
Kanamycin is a bactericidal antibiotic that 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, leading to bacterial cell death.
Pregnancy: Category D (US FDA). Aminoglycosides cross the placenta and can cause fetal ototoxicity (8th cranial nerve damage). Use only if the potential benefit justifies the potential risk to the fetus, such as in life-threatening MDR-TB. Requires extensive counselling.
Driving: Caution advised. Dizziness, vertigo, or tinnitus caused by the drug can impair the ability to drive or operate machinery.
| Furosemide/Ethacrynic acid | Potentiates ototoxicity (additive damage to cochlea) | Major |
| Other Aminoglycosides (Gentamicin, Amikacin) | Additive nephrotoxicity and ototoxicity | Major |
| Vancomycin | Additive nephrotoxicity | Major |
| Cisplatin | Additive nephrotoxicity and ototoxicity | Major |
| Neuromuscular blocking agents (e.g., Succinylcholine, Vecuronium) | Enhanced and prolonged neuromuscular blockade, risk of respiratory arrest | Major |
| Penicillins/Cephalosporins (in vitro) | Physical inactivation of aminoglycoside if mixed in same IV line/syringe | Moderate |
| Indomethacin in neonates | Increased risk of nephrotoxicity | Moderate |