📋 Clinical Overview

Kanamycin is an aminoglycoside antibiotic derived from *Streptomyces kanamyceticus*. It is bactericidal, 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).

💊 Dosage & Administration

Adult: For MDR-TB (RNTCP guidelines): 15 mg/kg body weight (max 1 gm) IM/IV once daily, 5-7 days/week. For systemic bacterial infections: 15 mg/kg/day in 1-2 divided doses (IM/IV).

Note: For IM use: Deep intramuscular injection into a large muscle mass (gluteus). Rotate sites. 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. Oral formulation is not absorbed systemically and is used for gut sterilization only.

⚠️ Contraindications

History of hypersensitivity to kanamycin or other aminoglycosides
Pre-existing significant auditory or vestibular impairment (e.g., Meniere's disease)
Concurrent use of other potent ototoxic or nephrotoxic drugs (e.g., other aminoglycosides, 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 mRNA, and causes premature termination of protein synthesis, leading to bacterial cell death.

🤕 Side Effects

Pain/induration at injection site
Mild proteinuria
Elevated serum creatinine (mild)

🤰 Special Populations

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

Driving: May impair ability to drive or operate machinery due to potential vestibular toxicity (dizziness, vertigo). Patients should be cautioned.

🔄 Drug Interactions

Other Aminoglycosides (Gentamicin, Amikacin)	Additive ototoxicity and nephrotoxicity	Major
Loop Diuretics (Furosemide, Ethacrynic acid)	Additive ototoxicity	Major
Vancomycin	Additive nephrotoxicity	Major
Cisplatin	Additive nephrotoxicity and ototoxicity	Major
Neuromuscular Blocking Agents (Succinylcholine, Tubocurarine)	Enhanced neuromuscular blockade, risk of prolonged apnea	Major
Penicillins (e.g., Carbenicillin, Ticarcillin) in vitro	Physical inactivation of aminoglycoside if mixed in same IV line/syringe	Moderate
IV Contrast Media	Increased risk of nephrotoxicity	Moderate

Kanamycin Sulfate