Kanamycin 1 g

A broad-spectrum aminoglycoside antibiotic produced by Streptomyces kanamyceticus. It has a bactericidal effect.

Active against Mycobacterium tuberculosis, Gram-negative bacteria: Escherichia coli, Shigella spp., Salmonella spp., Proteus spp., Enterobacter spp, Klebsiella pneumoniae, Neisseria gonorrhoeae, Neisseria meningitidis; Gram-positive cocci: Staphylococcus spp. (including strains producing penicillinase).

Pseudomonas spp., Streptococcus spp. are little or resistant to kanamycin.

Kanamycin is resistant to anaerobic bacteria, yeasts, viruses and most protozoa.

Indications

Treatment of the following diseases and conditions:

Active ingredient

Composition

How to take, the dosage

I/m, v/v (dropwise), in cavities.

In/v (dropwise): a single dose (0.5 g) is dissolved in 200 ml of 5% dextrose solution and administered at a rate of 60-80 drops/minute.

Infections of non-tuberculosis aetiology: single dose for adults – 0.5 g, daily dose – 1-1.5 g (0.5 g every 8-12 hours). The highest daily dose is 2 g. The course of treatment is 5-7 days. For children (only intravenous) – 0.05 g/kg/day; premature infants and children of the first month of life – only on vital indications.

In case of tuberculosis: intravenously, adults – 1 g once a day or 0.5 g 2 times a day, children – 0.015-0.02 g/kg/day, but not more than 0.5-0.75 g. Every 7th day – a break.

In cavities (pleural, abdominal, articular) for lavages 10-50 ml of 0.25% aqueous solution is administered. 500 mg (as 2.5% solution) is administered intraperitoneally. When performing peritoneal dialysis dissolve 1-2 g in 500 ml of dialysis fluid.

Application in the form of aerosol: in the form of aerosol and warm-humid inhalation (temperature – 35-40 ° C) is used in the treatment of pulmonary tuberculosis and respiratory tract infections of non-tuberculosis etiology. For this purpose 0.25-0.5 g is dissolved in 3-5 ml of 0.9% sodium chloride solution or distilled water. The single dose for adults is 0.5 g, for children – 5 mg/kg. The drug is administered twice a day. The daily dose is 0.5-1 g for adults and 15 mg/kg for children. Duration of treatment for acute diseases – 7 days; for chronic pneumonia – 15-20 days; for pulmonary tuberculosis – 1 month or more.

In case of renal insufficiency the scheme of administration is adjusted by reducing doses or increasing the intervals between injections. To calculate the intervals between injections taking into account the degree of renal impairment, the following formula can be recommended: Interval between injections in hours = plasma creatinine content (mg/100 ml) × 9.

Dose calculation

The initial dose is calculated with body weight in mind (dose, mg = body weight × 7).

The subsequent doses: the initial dose should be divided by the serum creatinine content (mg/100 ml). The frequency of administration is 2-3 times per day. On days of hemodialysis after hemodialysis an additional single dose of the drug is administered.

In order to avoid overdose of the drug, it is recommended to monitor the antibiotic concentration in the patient’s blood periodically.

Interaction

Pharmaceutically incompatible with streptomycin, gentamicin, monomycin, penicillins, heparin, cephalosporins, capreomycin, amphotericin B, erythromycin, nitrofurantoin.

Nalidixic acid, polymyxins, cisplatin and vancomycin increase the risk of ototoxicity and nephrotoxicity.

Diuretics (especially furosemide), cephalosporins, penicillins, sulfonamides and NSAIDs, competing for active secretion in nephron tubules, block elimination of aminoglycosides and increase their serum concentrations, increasing nephro- and neurotoxicity.

Parenteral administration of indomethacin increases the risk of kanamycin toxicity (increased T1/2 and decreased clearance).

Decreases the effect of antimiasthenic drugs. Increases the myorelaxant effect of curare-like drugs, general anesthetics and polymyxins.

Methoxyflurane, parenteral polymyxins and other drugs that block neuromuscular transmission (halogenated hydrocarbons as drugs for inhalation anesthesia, opioid analgesics), transfusion of large amounts of blood with citrate preservatives increase the risk of respiratory arrest (as a result of increased neuromuscular blockade).

Special Instructions

Key renal, auditory nerve and vestibular function should be monitored at least once a week during treatment.

The likelihood of nephrotoxicity is greater in patients with impaired renal function and when high doses are prescribed or for prolonged periods of time (daily monitoring of renal function may be necessary in this category of patients).

In case of unsatisfactory audiometric tests, the dose of the drug is reduced or treatment is stopped.

The aminoglycosides penetrate into breast milk in small amounts (since they are poorly absorbed from the gastrointestinal tract, no complications have been reported in infants).

Patients with infectious inflammatory diseases of the urinary tract are advised to take increased amounts of fluids.

In the absence of positive clinical dynamics, it is necessary to remember about the possibility of development of resistance of microorganisms. In these cases, treatment should be stopped and appropriate therapy should be initiated.

Contraindications

With caution: myasthenia gravis, parkinsonism, botulism (aminoglycosides may cause disruption of neuromuscular transmission, leading to further weakening of skeletal muscles), renal failure, elderly age, premature babies, period of newborns (up to 1 month), lactation period.

Side effects

Gastrointestinal disorders: nausea, vomiting, diarrhea, liver dysfunction (increased liver transaminase activity, hyperbilirubinemia).

Hematopoietic disorders: anemia, leukopenia, granulocytopenia, thrombocytopenia.

Nervous system disorders: headache, drowsiness, weakness, neurotoxic effect (muscle twitching, numbness, tingling sensation, paresthesia, epileptic seizures), possible violation of neuromuscular transmission.

Sense organs: ototoxicity (ringing or blocking sensation in the ears, decreased hearing up to permanent deafness), toxic effect on the vestibular system (discoordination of movements, dizziness, nausea, vomiting).

Urinary system disorders: nephrotoxicity – renal dysfunction (increased or decreased frequency of urination, thirst, cylinduria, microhematuria, albuminuria).

Allergic reactions: skin rash, itching, skin hyperemia, fever, Quincke’s edema.

Overdose

Symptoms: toxic reactions (hearing loss, ataxia, dizziness, urinary disorders, thirst, anorexia, nausea, vomiting, ringing or tinnitus, respiratory disorders).

Treatment: to relieve neuromuscular transmission blockade and its consequences – hemodialysis or peritoneal dialysis, administration of anticholinesterase agents, calcium salts, IVH, symptomatic and supportive therapy.