Classifications: antibiotic; aminoglycoside; Therapeutic: antibiotic
Pregnancy Category: D
75 mg, 500 mg; 1 g vials
Broad-spectrum, aminoglycoside antibiotic that binds irreversibly to aminoglycoside-binding sites on 30 S ribosomal subunit
of bacteria, subsequently inhibiting bacterial protein synthesis. To be bacteriocidal, an aminoglycoside needs to achieve
intracellular concentrations in excess of extracellular ones.
Usually bactericidal in action. Active against many aerobic gram-negative microorganisms, as well as some gram-positive
bacteria. It is not effective against anaerobic gram-negative bacteria.
Orally to reduce ammonia-producing bacteria in intestinal tract, as adjunctive treatment of hepatic coma, and for preoperative
bowel antisepsis; parenterally for short-term treatment of serious infections; intraperitoneally after fecal spill during
surgery; as irrigation solution; and as aerosol treatment. In conjunction with other drugs to treat tuberculosis in patients
resistant to conventional therapy.
History of hypersensitivity to kanamycin or other aminoglycosides; history of drug-induced ototoxicity, preexisting hearing
loss, vertigo, or tinnitus; long-term therapy; PO use in intestinal obstruction or ulcerative bowel lesions; intraperitoneally
to patients under effects of inhalation anesthetics or skeletal muscle relaxants; pregnancy (category D); infant <1 y.
Impaired renal function; older adults, neonates, and infants (immature renal systems); myasthenia gravis; parkinsonian syndrome.
Route & Dosage
|Preoperative Intestinal Antisepsis
Adult: PO 1 g q1h for 4 doses, then q6h for 3672 h
Adult: PO 812 g/d in divided doses
Adult/Child: IV/IM 15 mg/kg/d in equally divided doses q812h
Adult: Intraperitoneal 500 mg diluted in 20 mL sterile water instilled through wound catheter Inhalation 250 mg diluted in 3 mL NS administered per nebulizer q612h Irrigation 0.25% solution prn
Clcr 5080 mL/min: give 6090% of dose; 1050 mL/min: give 3070% of dose or q12h; less than 10
mL/min: give 2030% of dose or q2448h
- Give on a full or empty stomach.
- Store capsules at 15°30° C (59°86° F) unless otherwise directed.
- Administer IM injection deep into upper outer quadrant of gluteal muscle (often painful).
- Observe sites daily for signs of irritation; rotate injection sites.
PREPARE: Intermittent for Adult: Dilute each 500 mg with at least 100 mL NS, D5W, D5/NS, or other compatible solution. Intermittent for Child: Dilute each 2.55 mg in 1 mL of NS, D5W, D5/SW, or other compatible solution.
ADMINISTER: Intermittent for Adult/Child: Over 3060 min. Intermittent for Child: Use a constant-rate volumetric infusion device for administration.
INCOMPATIBILITIES Solution/additive: Amphotericin B, cefazolin, cefoxitin, ceftazidime, cefuroxime, cephalothin, cephapirin, chlorpheniramine, colistimethate,
heparin, hyaluronidase, hydrocortisone, lincomycin, methicillin, methohexital, nitrofurantoin, pentobarbital, phenobarbital,
prochlorperazine, sodium bicarbonate, thiopental, warfarin.
- Store vials at 15°30° C (59°86° F) unless otherwise directed. Some vials may darken with time,
but this does not affect potency.
- Discard partially used vials within 48 h.
Adverse Effects (≥1%)All:
Dose related. Body as a Whole:
Eosinophilia, maculopapular rash, pruritus, urticaria, drug fever, anaphylaxis. CNS:
Dizziness, circumoral and other paresthesias, optic neuritis
, peripheral neuritis
, headache, restlessness, tremors, lethargy,
convulsions; neuromuscular paralysis, respiratory depression
(rarely). Special Senses:
Deafness (can be irreversible), tinnitus, vertigo
ataxia, nystagmus. GI:
Nausea, vomiting, diarrhea, appetite changes, abdominal discomfort, stomatitis, proctitis, malabsorption syndrome (with
prolonged oral administration). Hematologic:
Anemia, increased or decreased reticulocytes, granulocytopenia, agranulocytosis,
thrombocytopenia, purpura. Urogenital: Nephrotoxicity
; hematuria, urine casts and cells, proteinuria; elevated serum creatinine and BUN. Other:
Superinfections; local pain; nodular formation at injection site.
InteractionsDrug: Amphotericin B, cisplatin, methoxyflurane, vancomycin
add to nephrotoxicity; general anesthetics
, skeletal muscle relaxants
add to neuromuscular blocking effects; capreomycin
compounds ototoxicity and nephrotoxicity; loop and thiazide diuretics
may increase risk of ototoxicity.
Poorly absorbed from GI tract; readily absorbed from peritoneal cavity, bronchial tree, and wounds. Peak:
12 h. Distribution:
Crosses placenta; distributed into breast milk. Elimination:
8090% in urine within 24 h. Half-Life:
Assessment & Drug Effects
- Lab tests: Monitor baseline C&S, urinalysis, and kidney function prior to initiation of therapy and periodically thereafter.
Monitor serum sodium, potassium, calcium, and magnesium.
- Notify physician immediately of signs of renal irritation: albuminuria, casts, red and white cells in urine, increasing BUN,
and serum creatinine, decreasing creatinine clearance, oliguria, and edema.
- Monitor peak and trough serum kanamycin concentrations: Assess peak specimen 3060 min after IM administration; 30
min after completion of a 3060 min IV infusion. Assess trough levels just before the next IM or IV dose.
- Keep patient well hydrated to prevent chemical irritation of renal tubules.
- Monitor I&O. Report decrease in urine output or change in I&O ratio.
- Determine baseline weight and vital signs and monitor at regular intervals during therapy.
- Report signs of superinfection (see Appendix F).
- Monitor for hearing and balance problems; stop drug if ototoxicity occurs. Tinnitus is not a reliable index of ototoxicity
in the very elderly. Risk of ototoxicity is high in patients with impaired renal function, older adults, poorly hydrated
patients, and with therapy ≥5 d.
- Note: Deafness has occurred 27 d or more after termination of therapy in patients with impaired renal function.
Patient & Family Education
- Report ototoxic symptoms such as dizziness, hearing loss, weakness, or loss of balance; drug may need to be discontinued.