Kanamycin Dosage

Applies to the following strengths: 500 mg/2 mL; 1 g/3 mL; 500 mg; 75 mg/2 mL

Usual Adult Dose for Bacterial Infection

Parenteral: 15 mg/kg/day IM or IV in divided doses every 8 to 12 hours
Duration: 7 to 10 days

Aerosol: 250 mg in 3 mL normal saline via nebulizer 2 to 4 times daily.

Irrigation: Kanamycin 2.5 mg/mL has been used for the irrigation of peritoneal and ventricular cavities, abscess cavities, and pleural space.

Maximum dose: The maximum recommended dose by all routes is 1.5 g/day. Serum levels should be monitored during treatment. Peak concentrations >35 mcg/mL and trough levels >10 mcg/mL should be avoided.

Usual Adult Dose for Peritonitis

Intraperitoneal, postsurgical: 500 mg in 20 mL sterile distilled water instilled into the wound at closure.

Maximum dose: The maximum recommended dose by all routes is 1.5 g/day. Serum levels should be monitored during treatment. Peak concentrations >35 mcg/mL and trough levels >10 mcg/mL should be avoided.

Usual Adult Dose for Tuberculosis - Active

15 mg/kg (maximum 1 g) IM or IV every 24 hours.

Should be given in combination with at least 3 other active drugs for treatment of multi-drug resistant TB, or when the patient is intolerant of first-line agents. AFB smear and culture should be monitored monthly.

Duration: Treatment for TB should generally continue for 18 to 24 months, or for 12 to 18 months after culture results are negative. Because of its toxicity, kanamycin is not indicated for long-term therapy.

Usual Pediatric Dose for Bacterial Infection

<7 days:
<2 kg: 15 mg/kg/day in divided doses every 12 hours.
>=2 kg: 15 to 20 mg/kg/day in divided doses every 12 hours.

>=7 days:
<2 kg: 15 to 22.5 mg/kg/day in divided doses every 8 hours.
>=2 kg: 15 to 30 mg/kg/day in divided doses every 8 hours.

>=1 month: 15 to 30 mg/kg/day in divided doses every 8 to 12 hours.

Usual Pediatric Dose for Tuberculosis - Active

15 to 30 mg/kg (maximum 1 g) IM or IV every 24 hours.

Should be given in combination with at least 3 other active drugs for treatment of multi-drug resistant TB, or when the patient is intolerant of first-line agents. AFB smear and culture should be monitored monthly.

Duration: Treatment for TB should generally continue for 18 to 24 months, or for 12 to 18 months after culture results are negative. Because of its toxicity, kanamycin is not indicated for long-term therapy.

Renal Dose Adjustments

Dosage should be adjusted in renal insufficiency. Various nomograms and methods have been proposed for determining the dosage in renally impaired patients - reduced doses at fixed intervals or normal doses at prolonged intervals. Regimens are ideally based on individualized pharmacokinetic dosing.

Adults:
The following adjustments to the maintenance dose have been suggested (modified from Sarubbi and Hull, 1978):
CrCl 70 to 80 mL/min: 76 to 91% of the loading dose every 8 to 12 hours
CrCl 60 to 70 mL/min: 71 to 88% of the loading dose every 8 to 12 hours
CrCl 50 to 60 mL/min: 65 to 84% of the loading dose every 8 to 12 hours
CrCl 40 to 50 mL/min: 72 to 92% of the loading dose every 12 to 24 hours
CrCl 30 to 40 mL/min: 63 to 92% of the loading dose every 12 to 24 hours
CrCl 20 to 30 mL/min: 50 to 81% of the loading dose every 12 to 24 hours
CrCl 10 to 20 mL/min: 34 to 75% of the loading dose every 12 to 24 hours
CrCl<10 mL/min: 21 to 47% of the loading dose every 24 hours or a onetime loading dose with subsequent doses based on serum concentrations, estimated clearance and the patient's condition.

The manufacturer recommends interval prolongation based on the serum creatinine (in mg/dL) multiplied by 9.

Liver Dose Adjustments

No adjustment recommended

Precautions

The use of aminoglycosides may result in nephrotoxicity and ototoxicity. The risk is greatest in patients with impaired renal function, those receiving high doses for prolonged periods of time, the elderly, and dehydrated patients. Aminoglycosides have been associated with permanent bilateral auditory and/or vestibular toxicity. Onset of ototoxicity may be delayed and cochlear damage may be asymptomatic, so deafness may not occur until after the drug has been discontinued. Monitoring patients for the development of toxicity is recommended: Serial, vestibular, audiometric, and renal function tests (creatinine clearance, BUN, urinalysis for proteinuria, decreased specific gravity, casts, and cells) should be performed before and during therapy. Patients and their family members should be informed of possible eighth cranial nerve toxicity. Tinnitus may be a sentinel symptom of ototoxicity.

NARROW THERAPEUTIC INDEX:

This drug should be considered a narrow therapeutic index (NTI) drug as small differences in dose or blood concentrations may lead to serious therapeutic failures or adverse drug reactions.

Recommendations:

Generic substitution should be done cautiously, if at all, as current bioequivalence standards are generally insufficient for NTI drugs.
Additional and/or more frequent monitoring should be done to ensure receipt of an effective dose while avoiding unnecessary toxicities.

Aminoglycosides have also been associated with other signs of neurotoxicity including numbness, skin tingling, muscle twitching, and convulsions.

The concomitant or sequential use of other systemic or topical neurotoxic or nephrotoxic drugs (e.g., certain antineoplastics, potent diuretics, vancomycin, other aminoglycosides) should be avoided. The concomitant use of aminoglycosides and cephalosporins has reportedly resulted in increased nephrotoxicity.

Significant amounts of kanamycin may be absorbed if administered by irrigation or local application and may potentially cause neurotoxicity and nephrotoxicity.

Kanamycin serum concentrations should be monitored and the dosage adjusted to maintain adequate levels and to avoid prolonged excessive peak concentrations. Peak concentrations over 35 mcg/mL and trough levels over 10 mcg/mL should be avoided. Close monitoring of renal function is recommended, especially in elderly patients.

Aminoglycosides may aggravate muscle weakness due to their potential curare-like effects on neuromuscular function, therefore kanamycin should be used cautiously in patients with muscular disorders such as myasthenia gravis or Parkinson's disease.

The possibility of neuromuscular blockade and respiratory paralysis exists if aminoglycosides are given to patients receiving anesthetics, neuromuscular blockers, or massive transfusions of citrate-anticoagulated blood. Calcium salts may reverse neuromuscular blockade if it occurs.

Paresthesias, tetany, mental confusion, muscle weakness, and positive Chvostek and Trousseau signs have been reported in hypomagnesemic, hypocalcemic, and hypokalemic patients during and after aminoglycosides treatment. Electrolyte levels should be monitored and corrected if necessary.

The sodium bisulfite preservative in some formulations of kanamycin may cause allergic, anaphylactic, or asthmatic reactions in sulfite-sensitive patients.

Patients should be well-hydrated during aminoglycoside treatment.

Aminoglycosides may cause fetal harm if administered during pregnancy.

Dialysis

Hemodialysis and peritoneal dialysis: Onetime loading dose, with subsequent doses based on serum concentrations, estimated clearance and the patient's condition.