Indications

Kanamycin Sulfate for Injection is indicated in combination with other antituberculosis agents for the treatment of tuberculosis caused by kanamycin-sensitive strains of Mycobacterium tuberculosis. Kanamycin is only indicated as a second-line antimycobacterial drug when first-line drugs cannot be used because of resistance or intolerance.

Dosage and Administration

Usage: Kanamycin is normally given by the intramuscular route, but can be given intravenously when intramuscular administration is not feasible.

Dosage:Adults and adolescents 15 years or older and weighing at least 30 kg

The usual dose is 15 mg/kg once daily on 5–7 days each week.

Precautions & Warning:

1. Ototoxicity: Both vestibular and auditory dysfunction can follow the administration of kanamycin.

2. Nephrotoxicity: Concentrations should be monitored for patients with impaired renal function. Interval adjustment is recommended for renal impairment or dialysis

3. Neurotoxicity: The risk of severe neurotoxic reactions is sharply increased in patients with impaired renal function or pre-renal azotemia.

4. Precautions: As kanamycin is potentially ototoxic, hearing (e.g. by audiometry) and vestibular function should be assessed before starting treatment and at monthly intervals during treatment.

Contraindications:

1.Hypersensitivity to kanamycin. Clinically significant hypersensitivity to other aminoglycosides may contraindicate the use of kanamycin because of known cross-sensitivity of patients to drugs in this class.

2.Pregnancy

Adverse Reactions:

1.The major toxic effects associated with kanamycin therapy are ototoxicity and nephrotoxicity. Kanamycin is considered one of the more toxic aminoglycosides.  

Nephrotoxicity : Renal side effects have included albuminuria, haematuria, azotaemia, oliguria, and increased serum creatinine and BUN. Acute renal failure may occur occasionally.

Ototoxicity and vestibular toxicity: Ototoxicity resulting in loss of vestibular function secondary to hair cell damage, and irreversible or partially reversible bilateral hearing loss has been observed. Nystagmus, vertigo, nausea, vomiting, and acute Meniere's syndrome are signs of vestibular dysfunction. Cochlear damage may be asymptomatic and may initially manifest as minor changes in audiometric test results at higher frequencies.

Neurotoxicity: Nervous system side effects have included neuromuscular blockade. Aminoglycosides have been associated with acute muscular paralysis, apnoea, peripheral neuropathy and encephalopathy (numbness, paraesthesia, muscle twitching, seizures), and myasthenia gravis-like syndrome. Neurotoxicity may occur after intrapleural, intraperitoneal, or parenteral administration. Patients with renal impairment may be at a higher risk.

2.Other adverse reactions reported are anaphylaxis, hypersensitivity reactions, rash, anaemia, blood dyscrasias, purpura, headache, nausea, vomiting, diarrhoea, stomatitis, antibiotic–associated colitis, electrolyte disturbances, and effects on liver function. The “malabsorption syndrome” characterized by an increase in faecal fat, decrease in serum carotene, and fall in xylose absorption, has occurred with prolonged therapy.

3.Injection-site reactions: Local reactions have included pain at the injection site after intramuscular injection

Drug interactions:

Simultaneous administration of other antituberculous drugs which also have ototoxic and nephrotoxic potential (e.g. streptomycin, amikacin) is not recommended. Also, administration with other neurotoxic, ototoxic or nephrotoxic drugs to patients receiving kanamycin should be avoided. These include other aminoglycoside antibiotics, polymyxin, colistin, vancomycin, cephalosporins, amphotericin B, ciclosporin, cisplatin, and loop diuretics (e.g. furosemide, etacrynic acid, mannitol).

Storage instructions:

Store below 30°C. Avoid freezing.