COMPANION HANDBOOK TO THE WHO GUIDELINES FOR THE PROGRAMMATIC MANAGEMENT OF DRUG-RESISTANT TUBERCULOSIS
Kanamycin (Km)
DRUG CLASS: AMINOGLYCOSIDE
Activity against TB, Bactericidal; has strong anti-TB activity. Cross-resistance with
mechanism of action, amikacin and some data suggesting cross-resistance with
and metabolism capreomycin; inhibits protein synthesis.
Dose Adults: 15 mg/kg/day in a single daily dose, 5–7 days per week
(maximum dose is generally 1 gram, but a large, well-built person
could receive more and should have concentrations monitored).
>59 years of age: 10 mg/kg/dose (max 750 mg) 5–7 times per
week or 2–3 times per week after initial period. Alternatively,
15 mg/kg/dose, 3 times per week.
Children: 15–30 mg/kg/day (max 1 gram) 5–7 days per week.
Renal failure/dialysis: 12–15 mg/kg/dose, 3 times weekly.
Markedly obese individuals should have an adjusted dose due
to the decreased distribution of extracellular fluids in adipose
tissues. Dosing based on actual weight will give supratherapeutic
concentrations.
For dosing, use adjusted weight as follows: Ideal body weight +
40% of excess weight
Ideal body weight (men): 50 kg plus 2.3 kg/inch over 5 ft
Ideal body weight (women): 45 kg plus 2.3 kg/inch over 5 ft
If possible, concentrations should be followed closely.
Route of administration IV or IM; not absorbed orally.
Preparation 250 mg/ml in vials of 500 mg or 1 gram; 1 gram in 3 ml vial; or
75 mg/vial for infants. Can be mixed with D5W or normal saline
for intravenous infusion. Adult IV doses should be mixed in at
least 100 ml of fluid, and paediatric IV doses should be mixed to a
concentration of at least 5 mg/ml. For intravenous administration,
infuse over 60 minutes for adults; 1–2 hours for children.
Storage Store in the refrigerator.
Oral absorption Not absorbed orally; 40–80% of the dose is absorbed
intramuscularly.
CSF penetration Minimal and variable CSF penetration – slightly better with
inflammed meninges.
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Anti-TB drug information sheets
Special circumstances Use in pregnancy/breastfeeding: Generally avoided in pregnancy
due to documented congenital deafness. Can be used while
breastfeeding.
Use in renal disease: Use with caution. Concentrations should
be monitored for patients with impaired renal function. Interval
adjustment is recommended for renal impairment or
dialysis. See section above for dosage under renal disease or
dialysis. The drug is variably cleared by haemodialysis.
Use in hepatic disease: Drug concentrations are not affected by
hepatic disease (except a larger volume of distribution for alcoholic
cirrhotic patients with ascites). Presumed to be safe in severe liver
disease; however, use with caution because patients with severe
liver disease may progress rapidly to hepatorenal syndrome.
Diuretic use: Coadministration of loop diuretics and aminoglycoside
antibiotics carries an increased risk of ototoxicity.
Adverse reactions Nephrotoxicity: Appears to be more nephrotoxic than streptomycin.
Ototoxicity (hearing loss) and vestibular toxicity: Increases with
advanced age and prolonged use; appears to occur slightly more
commonly with kanamycin than with streptomycin and
about the same frequency as amikacin. Kanamycin seems to have
slightly less vestibular toxicity.
Contraindications Pregnancy (congenital deafness seen with streptomycin and
kanamycin use in pregnancy); hypersensitivity to aminoglycosides;
caution with renal, vestibular or auditory impairment; patients with
intestinal obstructions.
Monitoring Monitor renal function by documenting creatinine at least monthly
(more frequently if renal or hepatic impairment is present);
document creatinine clearance if there is baseline renal impairment
or any other concern; document baseline and monthly audiology
exam. Question patient regularly about vestibular complaints
and perform serial vestibular exams. Document peak and trough
concentrations at baseline if there is any question about renal
function. Some experts
monitor aminoglycoside concentrations routinely, regardless of
renal function. Monitor concentrations serially for patients with
impaired renal function.
Alerting Symptoms Instruct patients to inform their health care provider right away if
any of the following occurs:
• Problems with hearing, dizziness or balance
• Rash or swelling of your face
• Trouble breathing
• Decreased urination
• Watery or bloody diarrhoea
• Swelling, pain, or redness at your IV site
• Muscle twitching or weakness.
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