KANAMYCIN
| KANAMYCIN (kan-a-mye'sin) Kantrex Classifications: antibiotic; aminoglycoside; Therapeutic: antibiotic Prototype: Gentamicin Pregnancy Category: D |
Availability
75 mg, 500 mg; 1 g vials
Action
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.
Therapeutic Effect
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.
Uses
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.
Contraindications
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.
Cautious Use
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 36–72 h Hepatic Coma Adult: PO 8–12 g/d in divided doses Serious Infection Adult/Child: IV/IM 15 mg/kg/d in equally divided doses q8–12h 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 q6–12h Irrigation 0.25% solution prn Renal Impairment Clcr 50–80 mL/min: give 60–90% of dose; 10–50 mL/min: give 30–70% of dose or q12h; less than 10 mL/min: give 20–30% of dose or q24–48h |
Administration
Oral- 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.
| Intravenous 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 2.5–5 mg in 1 mL of NS, D5W, D5/SW, or other compatible solution. ADMINISTER: Intermittent for Adult/Child: Over 30–60 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 or dizziness, 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.Interactions
Drug: 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, carboplatin may increase risk of ototoxicity.Pharmacokinetics
Absorption: Poorly absorbed from GI tract; readily absorbed from peritoneal cavity, bronchial tree, and wounds. Peak: 1–2 h. Distribution: Crosses placenta; distributed into breast milk. Elimination: 80–90% in urine within 24 h. Half-Life: 2–4 h.Nursing Implications
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 30–60 min after IM administration; 30 min after completion of a 30–60 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 2–7 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.
Common adverse effects in italic, life-threatening effects underlined; generic names in bold; classifications in SMALL CAPS; 
Canadian drug name; 
Prototype drug