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INTRODUCTION

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kanamycin (kan-a-mye-sin)

Kantrex

Classification

Therapeutic: anti-infectives

Pharmacologic: aminoglycosides

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Indications
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IM, IV: Treatment of serious infections when other less toxic drugs are contraindicated.

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Action
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Inhibits protein synthesis in bacteria at level of 30S ribosome. Therapeutic Effects: Bactericidal action. Spectrum: Notable for activity against Klebsiella pneumoniae, Escherichia coli, Proteus, Serratia marcescens, Enterobacter aerogenes, Acinetobacter, Staphylococcus aureus.

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Adverse Reactions/Side Effects
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EENT: ototoxicity (vestibular and cochlear). GU: nephrotoxicity. MS: muscle paralysis (high parenteral doses). Misc: hypersensitivity reactions.

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PHYSICAL THERAPY IMPLICATIONS

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Examination and Evaluation
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  • Monitor signs of hypersensitivity reactions, including pulmonary symptoms (tightness in the throat and chest, wheezing, cough dyspnea) or skin reactions (rash, pruritus, urticaria). Notify physician or nursing staff immediately if these reactions occur.

  • Report any muscle weakness or paralysis that occurs following injection of high doses.

  • Monitor signs of ototoxicity, including hearing loss, tinnitus, and balance problems (See Appendix E for Fall Assessment and Prevention). Report these signs, and caution the patient and family/caregivers to guard against falls and trauma.

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Interventions
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  • Always wash hands thoroughly and disinfect equipment (whirlpools, electrotherapeutic devices, treatment tables, and so forth) to help prevent the spread of infection. Use universal precautions or isolation procedures as indicated for specific patients.

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Patient/Client-Related Instruction
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  • Advise patient to report signs of nephrotoxicity, including blood or pus in urine, decreased urine output, fatigue, and weight gain from fluid retention.

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Pharmacokinetics
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Absorption: Well absorbed after IM administration. IV administration results in complete bioavailability.

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Distribution: Widely distributed throughout extracellular fluid; crosses the placenta; small amounts enter breast milk. Some penetration into CSF when meninges are inflamed.

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Metabolism and Excretion: Excretion is >90% renal.

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Half-life: 2–4 hr (increased in renal impairment).

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TIME/ACTION PROFILE (blood levels*)

ROUTE ONSET PEAK DURATION
IM rapid 30–90 min N/A
IV rapid 15–30 min N/A

*All parenterally administered aminoglycosides.

Postdistribution peak occurs 30 min after the end of a 30-min infusion and 15 min after the end of a 1-hr infusion.

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Contraindications/Precautions
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Contraindicated in: Hypersensitivity to kanamycin or other aminoglycosides; Pregnancy.

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Use Cautiously in: Renal impairment (dosage adjustments necessary; blood level monitoring useful in preventing ototoxicity and nephrotoxicity); Hearing impairment; Geriatric patients and premature infants (difficulty in assessing auditory and vestibular function; age-related renal impairment); Neonates (increased risk of neuromuscular blockade; difficulty in assessing auditory and vestibular function; immature renal function); Neuromuscular diseases such as myasthenia gravis; Lactation (safety not established).

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Interactions
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Drug-Drug: Inactivated by penicillins and cephalosporins...

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