K

International Brand Names

Kamycine (France); Kanacin (Korea); Kanamed (Thailand); Kanamicina Gen-Far (Peru); Kanamycin Capsules Meiji (Thailand); Kanamycin Meiji (Hong Kong, Philippines); Kanamycin Novo (South Africa); Kanamycin Sanbe (Indonesia); Kancin (India, Malaysia, Philippines, Taiwan, Thailand); Kanoxin (Indonesia, Thailand); Randikan (Mexico)

Drug Class	Aminoglycosides; Antibiotics
Indications	Bacterial infection
Mechanism	Inhibits protein synthesis by binding the 30S ribosomal subunit, leading to cell destruction
Dosage With Qualifiers	Bacterial infection—15 mg/kg/d IM/IV in 2–3 divided doses NOTE: Renal dosing; peak 25–35 mcg/mL, trough < 10 mcg/mL. Contraindications —hypersensitivity to drug or class Caution —myasthenia gravis, other nephrotoxic agents, renal dysfunction, vestibular or cochlear implant
Maternal Considerations	There are no adequate reports or well-controlled studies in pregnant women. Kanamycin is a second-line agent for the treatment of TB, but it is otherwise not used widely during pregnancy and offers no advantages over other aminoglycosides. Routine monitoring of peak and trough levels is not required in otherwise healthy women with normal renal function. It is also used to treat septic abortion with a cephalosporin. Side effects include nephrotoxicity, ototoxicity, tinnitus, enterocolitis, pseudotumor cerebri, pruritus, N/V, diarrhea, weakness, tremor, muscle cramps, anorexia, edema, vertigo, agranulocytosis, thrombocytopenia, and elevated BUN/Cr.
Fetal Considerations	There are no well-controlled studies in human fetuses. Case reports suggest the degree of human placental transfer is incomplete. Kanamycin crosses the placenta in rodents, and most likely in humans, as other aminoglycosides do. There is no evidence of teratogenicity for any of the aminoglycosides. In guinea pigs, doses of kanamycin 20 × the MRHD had no obvious side effects. However, otic nerve damage has been reported after an in utero –exposed neonate was challenged postnatally.
Breastfeeding Safety	There are no adequate reports or well-controlled studies in nursing women. Kanamycin enters human breast milk, but it is generally considered compatible with breastfeeding.
Drug Interactions	In vitro mixing of an aminoglycoside with β-lactam–type antibiotics (penicillins or cephalosporins) may result in significant mutual inactivation. A reduction in aminoglycoside serum t/2 or serum levels has been reported in patients with impaired renal function and in some patients with normal renal function even when administered separately by different routes. Such inactivation is usually clinically significant only in the setting of severely impaired renal function. Concurrent and/or sequential use of diuretics or other neurotoxic and/or nephrotoxic antibiotics may increase the prevalence and severity of adverse responses.
References	Czeizel AE, Rockenbauer M, Olsen J, Sorensen HT. Scand J Infect Dis 2000; 32:309-13. Good RG, Johnson GH. Obstet Gynecol 1971; 38:60-2. Pacifici GM. Int J Clin Pharmacol Ther 2006; 44:57-63. Udoh A, Effa EE, Oduwole O, Okusanya BO, Okafo O. Cochrane Database Syst Rev. 2016 Jul 1;7:CD011528. Wang Z, Liou L. Ann Otol Rhinol Laryngol 1994; 103:983-5.
Summary	Pregnancy Category: D Lactation Category: S (likely) For most indications, there are alternative agents for which there is more experience during pregnancy and lactation.