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 Zambia HIV National Guidelines
 


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 Guide Editors
 Editor In Chief
    Joel E. Gallant, MD, MPH

Pharmacology Editor
    Paul Pham, PharmD, BCPS

Zambia Guideline Team
   Peter Mwaba MMed PhD FRCP
   Alywn Mwinga MMed
   Isaac Zulu MMed MPH
   Velepie Mtonga MMed
   Albert Mwango MBChB
   Jabbin Mulwanda MMed FCS
 

 

 

Drugs>Antimicrobial Agents>
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Kanamycin

Paul A. Pham Pharm.D. and Alice M. Jehn Pharm.D.
06-08-2009

Zambia Specific Information

  • Available formulation in Zambia: Powder for injection: 1000 mg vial.
  • Reserved for the treatment of MDR-TB in combination with ethionamide, pyrazinamide, ofloxacin, and ethambutol.
  • MDR-TB standardized regimen: kanamycin 750 mg/d (<50 kg); 1000 mg/d (>50 kg) plus ethionamide, pyrazinamide, ofloxacin, and ethambutol x 4 month, then based on culture conversion and sensitivity, continue with ethionamide, ofloxacin, and ethambutol for 12-18 months.

REFERENCES

Zambia Information Author: Paul A. Pham, Pharm. D.

INDICATIONS

FDA

  • Bowel sterilization (capsule, no longer available in the U.S.)
  • Hepatic encephalopathy (capsule, no longer available in the U.S.)
  • Short-term treatment of infections caused by E. coli, Proteus species (both indole-positive and indole-negative), Enterobacter aerogenes, Klebsiella pneumoniae, Serratia marcescens, Acinetobacter species.
  • Staphylococcal infections (not drug of choice)
NON-FDA APPROVED USES

  • Treatment of multi-drug resistant Mycobacterium tuberculosis  (second line)
  • Non-tubercular mycobacterial infections
  • Gram-negative infections
  • Gonorrhea
  • Urinary tract infections 

FORMS

brand 
name
 
generic 
Mfg 
brand 
forms
 
cost* 
KantrexKanamycin Generic manufacturer (App Pharmaceutical) IV
vial
1g/3mL
$18.13 per 3mL 

*Prices represent cost per unit specified and are representative of "Average Wholesale Price" (AWP). AWP Prices were obtained and gathered by Lakshmi Vasist Pharm D using the Red Book, manufacturer's information, and the McKesson database.

^Dosage is indicated in mg unless otherwise noted.

USUAL ADULT DOSING

 

  • MDR-TB treatment: 15mg/kg/day IM in divided doses q8-12 hrs.
  • For gram-negative infections: target peak of 25-30 mcg/mL and target trough of <10 mcg/mL is generally recommended.

RENAL DOSING

DOSING FOR GLOMERULAR FILTRATION OF 50-80

60-90% of usual dose q12h or 100% of usual dose q12-24 hrs (monitor peaks and troughs).

DOSING FOR GLOMERULAR FILTRATION OF 10-50

30-70% of usual dose q 12-18h or 100% of usual dose q24-48 hrs (monitor peaks and troughs).

DOSING FOR GLOMERULAR FILTRATION OF <10 ML/MIN

20-30% of usual dose q24-48 hrs or 100% q48-72 hrs (monitor peaks and troughs; redose with troughs <2mcg/mL).

DOSING IN HEMODIALYSIS

4-5 mg/kg post-dialysis (monitor peaks and troughs).

DOSING IN PERITONEAL DIALYSIS

3.75 mg/kg/day (monitor peaks and troughs). Aminoglycosides given for prolonged periods to patients receiving continuous peritoneal dialysis have been associated with high rates of ototoxicity. Monitor levels after loading dose and follow for symptoms of ototoxicity.

DOSING IN HEMOFILTRATION

Limited data. Consider 3-5mg/kg x1 (load), then 2-4mg/kg q24-48hr. Monitor peaks and troughs.

ADVERSE DRUG REACTIONS

GENERAL

  • Allergy uncommon
  • Cross sensitivity to neomycin (80.9%) and gentamicin (62%)
COMMON

  • Renal failure (usually reversible)
OCCASIONAL

  • Vestibular and auditory damage, usually irreversible. Genetic predisposition possible (check family for aminoglycoside ototoxicity history).
  • GI intolerance: nausea. vomiting, diarrhea, and malabsorption syndrome with oral kanamycin
  • Rash
RARE

  • Neuromuscular blockade with large doses and rapid infusion
  • Neurotoxicity: headache, paresthesias, and blurred vision

DRUG INTERACTIONS

  • BCG and Live Typhoid Vaccine: may reduce vaccine efficacy.
  • Loop diuretics (especially ethacrynic acid) and capreomycin: additive ototoxicity. Avoid co-administration .
  • Nephrotoxic agents (e.g., ampho B, cidofovir, foscarnet, capreomycin, furosemide, tacrolimus, cyclosporine): additive nephrotoxicity. Avoid co-administration.
  • Penicillins: in vitro inactivation of aminoglycoside. Do not mix together before administration (i.e., running in the same line or concurrent intraperitoneal administration).

SPECTRUM

Most mycobacteria, but limited activity against MAI. Active against most gram-negative aerobes, but anti-pseudomonal activity is not reliable. Not active against anaerobes.

Detailed Spectrum of Activity

PHARMACOLOGY

Pharmacology

COMMENTS

Parenteral aminoglycoside used primarily for MDR-TB. No reliable anti-pseudomonal activity. Ototoxicity similar to streptomycin. Sometimes used orally for bowel prep in elective colon surgery, but oral form not longer available in the U.S.

REFERENCES

REFERENCED WITHIN THIS GUIDE


 
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