Kanamycin
Pronunciation: KAN-a-MY-sin.
- Generic name
- kanamycin sulfate
- Brand names
- Kantrex (United States, historical -- discontinued)
- Drug class
- Aminoglycoside antibiotic
- Form
- Injection (solution, 1 g per 3 mL vial in the last marketed US presentation)
- Route
- Intramuscular or intravenous injection (historically also intraperitoneal or inhaled/aerosol use is described in older product labelling)
- Legal status
- Prescription-only, hospital/clinician-administered injectable; no longer marketed as a branded or generic human product in the United States, and not confirmed as currently registered for human use in the United Kingdom, European Union, Canada, Australia, or New Zealand.
Availability and supply rules vary by country
Trade names by country: United States
Australia: · Full directory
Boxed warning: Serious risk of hearing loss, kidney damage, and neuromuscular blockade
People treated with kanamycin, like other aminoglycoside antibiotics, need close clinical observation because of the potential for serious toxicity. The two major concerns are damage to the eighth cranial nerve, which can cause hearing loss and balance (vestibular) problems that are sometimes permanent and may not appear until after treatment has ended, and damage to the kidneys (nephrotoxicity), which is usually reversible if caught early. Kanamycin can also cause neuromuscular blockade with acute muscle paralysis and breathing failure (respiratory paralysis), particularly when given together with anaesthetics or muscle-relaxant drugs, or in people with a neuromuscular disorder such as myasthenia gravis. Because of these risks, kanamycin is only given by, or under the direction of, a clinician in a setting where kidney function and hearing can be monitored and breathing support is available if needed. (1) (2)
What kanamycin sulfate is and how it works
Kanamycin is an injectable aminoglycoside antibiotic used for certain serious bacterial infections, given only by or under the direction of a clinician in a hospital or clinical setting. (1) (3)
Kanamycin is never a medicine you administer to yourself. It is given by injection by trained healthcare staff, who will monitor your kidney function, hearing, and blood drug levels throughout treatment because of its real risk of hearing loss, kidney damage, and, less commonly, severe muscle weakness or breathing problems. Kanamycin is a legacy antibiotic: it is no longer marketed as a branded or generic product in the United States, and it could not be confirmed as a currently available product in the United Kingdom, European Union, Canada, Australia, or New Zealand either -- newer, related antibiotics (such as amikacin, gentamicin, or tobramycin) are the medicines now typically used in its place.
Mechanism of action: how kanamycin sulfate works
Kanamycin is an aminoglycoside antibiotic that binds the bacterial 30S ribosomal subunit, causing misreading of mRNA and inhibition of bacterial protein synthesis, which is bactericidal against susceptible gram-negative and some gram-positive organisms. (1) (2)
What kanamycin sulfate is used for
Serious bacterial infections (historical indication)
Kanamycin's approved use was short-term treatment of serious infections caused by certain susceptible gram-negative bacteria (such as E. coli, Proteus, Enterobacter, Klebsiella, Serratia, and Acinetobacter species) and some staphylococcal infections, when safer options were not effective or not suitable. It was sometimes started alongside a penicillin- or cephalosporin-type antibiotic for serious infections of unknown cause, and was not intended for long-term treatment such as tuberculosis. (1)
Before taking kanamycin sulfate
Do not take / not appropriate for
- Kanamycin is contraindicated in anyone with a history of a hypersensitivity or toxic reaction to kanamycin or to any other aminoglycoside antibiotic, because of a real risk of cross-sensitivity between aminoglycosides. (all countries) (1)
Tell your clinician about
- Any personal history of hearing problems, balance problems, or previous reactions to any aminoglycoside antibiotic.
- Any kidney problems, since kanamycin dosing must be adjusted for reduced kidney function.
- Any neuromuscular condition such as myasthenia gravis, or plans for surgery involving anaesthesia or muscle relaxants.
- All other medicines you are taking, especially other antibiotics, diuretics ('water tablets'), or any other potentially kidney- or hearing-affecting medicine.
- Pregnancy, plans for pregnancy, or breastfeeding.
- Any known sulfite sensitivity or asthma, since some kanamycin formulations contain sodium bisulfite.
How to take kanamycin sulfate
- Kanamycin is given only by injection (into a muscle or a vein) by trained healthcare staff -- it is never a medicine you take or administer yourself.
- Your prescriber sets the dose, injection route, and length of treatment individually, based on your body weight, kidney function, and the infection being treated.
- You will have blood tests during treatment to check your kidney function and, where available, the level of kanamycin in your blood, so your prescriber can keep dosing in a safe range.
- Report any new hearing changes, ringing in the ears, dizziness, or reduced urination promptly, so your care team can assess whether any change to your treatment is needed.
Procedures and treatment changes
Tell the treating team before surgery, procedures, or any medicine change. Do not alter treatment without the responsible clinician. (1) (2) (3) (4) (5) (6) (7) (8)
Missed dose
Because kanamycin is given by clinical staff in a monitored setting, a missed dose is managed directly by your care team based on your treatment schedule and blood test results, not by you.
Overdose
Because kanamycin is administered by healthcare staff who monitor blood drug levels, kidney function, and hearing throughout treatment, any concern about too high a dose is assessed and managed directly by your clinical care team, including adjusting monitoring and supportive care as needed. (1)
Side effects
Side effects and their urgency vary; report severe, persistent, or concerning symptoms.
Injection site irritation or pain.
What to notice: Injection site irritation or pain.
What to do: Discuss persistent or troublesome symptoms with the treating clinician or pharmacist. (1)
Nausea, vomiting, or diarrhoea.
What to notice: Nausea, vomiting, or diarrhoea.
What to do: Discuss persistent or troublesome symptoms with the treating clinician or pharmacist. (1)
Headache or tingling sensations (paresthesia).
What to notice: Headache or tingling sensations (paresthesia).
What to do: Discuss persistent or troublesome symptoms with the treating clinician or pharmacist. (1)
Skin rash or drug fever.
What to notice: Skin rash or drug fever.
What to do: Discuss persistent or troublesome symptoms with the treating clinician or pharmacist. (1)
Serious warnings
Hearing or balance changes (ototoxicity) — boxed_warning
Symptoms: Ringing in the ears (tinnitus), hearing loss, dizziness, or unsteadiness/loss of balance (vertigo).
Action: Tell your care team immediately -- this effect can be permanent and may not appear until after treatment ends, so any hearing or balance symptom needs prompt clinical assessment, including whether continued treatment remains appropriate. (1)
Kidney problems (nephrotoxicity) — boxed_warning
Symptoms: Reduced urination, swelling, or unusual tiredness; often detected first through blood and urine tests rather than obvious symptoms.
Action: Your care team will monitor kidney function throughout treatment with blood and urine tests and adjust your care as needed; this effect is usually reversible if identified early. (1)
Severe muscle weakness or breathing difficulty (neuromuscular blockade/respiratory paralysis) — emergency
Symptoms: Sudden severe muscle weakness, difficulty breathing, or shallow breathing, especially if you have recently had anaesthesia or a muscle-relaxant medicine.
Action: This is a medical emergency -- it is monitored for and treated immediately by the clinical team administering kanamycin, with breathing support available if needed. (1)
Allergic-type reaction (in formulations containing sodium bisulfite) — high caution
Symptoms: Wheezing, hives, itching, or difficulty breathing, particularly in people with asthma or known sulfite sensitivity.
Action: Tell your care team immediately about any allergic-type symptoms so they can treat the reaction and reassess your treatment plan. (2)
Interactions
- Potent diuretics ('water tablets') such as ethacrynic acid or furosemide can increase the risk of both hearing damage and kidney damage when combined with kanamycin. (1)
- Other drugs that can affect the kidneys or hearing (such as other aminoglycoside antibiotics, vancomycin, amphotericin B, polymyxin B, bacitracin, or cisplatin) can add to kanamycin's risk if combined -- your care team will weigh this carefully. (1)
- Beta-lactam antibiotics (such as penicillins) mixed directly with kanamycin in the same solution can inactivate each other; your care team will keep these separate. (1)
- Medicines used during anaesthesia or surgery, including muscle relaxants, can add to kanamycin's risk of severe muscle weakness or breathing problems. (1)
Pregnancy, breastfeeding, kidney/liver function, age
Pregnancy
Aminoglycosides such as kanamycin cross the placenta. Fetal harm, including congenital deafness, has been associated with a related aminoglycoside (streptomycin), and animal studies with kanamycin have shown hearing impairment in offspring at high doses. Kanamycin would only be used in pregnancy if a prescriber judges it clearly necessary and no safer alternative is suitable. (1) (2) (3) (4) (5) (6) (7) (8)
Breastfeeding
Kanamycin passes into breast milk in small amounts. Whether to breastfeed during treatment should be discussed individually with your care team. (1) (2) (3) (4) (5) (6) (7) (8)
Children
Historical labelling describes use in children with dosing adjusted individually; use in children is directed entirely by the treating clinician. (1) (2) (3) (4) (5) (6) (7) (8)
Elderly
Kidney function commonly declines with age, so older adults may need closer monitoring and dose-interval adjustment. (1) (2) (3) (4) (5) (6) (7) (8)
Hepatic_impairment
Not specifically addressed in the sources reviewed for this dossier; kanamycin is cleared mainly by the kidneys rather than the liver. (1) (2) (3) (4) (5) (6) (7) (8)
Renal_impairment
Kidney function directly determines dosing -- reduced kidney function requires a longer interval between doses, set individually by the treating clinician based on blood tests. (1) (2) (3) (4) (5) (6) (7) (8)
Source_ids
US-DRUGSCOM-KANTREX-ARCHIVED-FDA-LABEL,US-DRUGSCOM-KANAMYCIN-FRESENIUS-LABEL (1) (2) (3) (4) (5) (6) (7) (8)
Monitoring
Before starting
- Baseline kidney function tests
- Baseline hearing assessment where feasible
- Review of other medicines that could add to kidney or hearing risk
During treatment
- Regular kidney function blood tests throughout treatment.
- Monitoring of kanamycin blood levels where available, to keep peak and trough levels in a safe range.
- Watching for hearing or balance changes, and for signs of muscle weakness or breathing difficulty.
- Urine output monitoring.
Storage
Historical labelling specifies storage at room temperature, 20-25 degC (68-77 degF). As a clinician-administered hospital medicine, storage and handling are managed by the pharmacy and clinical team, not by patients.
Study the drug class: Aminoglycosides
Professional information
Clinician-facing context only, sourced from archived FDA-approved prescribing information for Kantrex and generic kanamycin injection (both now discontinued in the US); no current, actively maintained label exists in any of the 6 standard markets reviewed. Verify against current local antimicrobial stewardship guidance before any use, given the drug's discontinued/legacy status.
United States (historical)
Indication: Serious infections caused by susceptible bacteria
Dose summary: Historical labelling: intramuscular 15 mg/kg/day in two divided doses (7.5 mg/kg every 12 hours), maximum 1.5 g/day; intravenous not exceeding 15 mg/kg/day infused over 30-60 minutes; dosing interval extended for renal impairment; typical course 7-10 days with monitoring of peak/trough serum levels and renal function.
Renal context: Dose interval must be individually extended for reduced creatinine clearance; the historical label describes calculating the interval from serum creatinine -- always individualised to current renal function and blood levels, not a fixed public number. (1)
Hepatic guidance
Not specifically detailed in the sources reviewed; kanamycin is renally eliminated, so hepatic impairment is not the primary dosing consideration.
Overdose note
Excess exposure raises the risk of nephrotoxicity, ototoxicity, and neuromuscular blockade; management involves supportive care, monitoring of renal function and serum drug levels, and consideration of hemodialysis to help remove the drug in significant overdose, per historical labelling. (1) (2)
Frequently asked questions
Is kanamycin still available today?
Kanamycin injection (brand name Kantrex, and its generic versions) has been discontinued and is no longer marketed in the United States. Direct checks of the UK, EU, Canadian, Australian, and New Zealand medicine registers found no currently marketed human kanamycin product in any of them either. Newer, related aminoglycoside antibiotics -- amikacin, gentamicin, and tobramycin -- are the medicines now typically used in its place. (1) (3) (6) (7)
Can I give myself kanamycin at home?
No. Kanamycin is given only by injection by trained healthcare staff in a monitored clinical setting, because of its real risk of hearing loss, kidney damage, and, less commonly, severe muscle weakness or breathing problems. (1)
Why does kanamycin require regular blood tests?
Kanamycin can damage the kidneys and, separately, the hearing and balance nerves. Regular blood tests check kidney function and, where available, the level of kanamycin in the blood, so the dose and timing can be kept in a safer range throughout treatment. (1)
What is the mechanism of action of kanamycin sulfate?
Kanamycin is an aminoglycoside antibiotic that binds the bacterial 30S ribosomal subunit, causing misreading of mRNA and inhibition of bacterial protein synthesis, which is bactericidal against susceptible gram-negative and some gram-positive organisms. (1) (2)
References
- Kantrex (Kanamycin Sulfate) Injection -- full prescribing informationArchived FDA-approved full prescribing information for Kantrex (kanamycin sulfate injection), as mirrored by Drugs.com's professional monograph database · United States · accessed 2026-07-30 · source 1
- Kanamycin Injection, USP -- full prescribing informationArchived FDA-approved full prescribing information for Kanamycin Injection, USP, as mirrored by Drugs.com's professional monograph database · United States · accessed 2026-07-30 · source 2
- DailyMed search results for 'kanamycin'DailyMed (U.S. National Library of Medicine) · United States · accessed 2026-07-30 · source 3
- emc search for kanamycinelectronic medicines compendium (emc), United Kingdom · United Kingdom · accessed 2026-07-30 · source 4
- EMA published documents referencing kanamycinEuropean Medicines Agency (EMA) · European Union · accessed 2026-07-30 · source 5
- Health Canada DPD API query for ingredient 'kanamycin'Health Canada Drug Product Database (DPD), official public API · Canada · accessed 2026-07-30 · source 6
- TGA PICMI search for 'kanamycin'Therapeutic Goods Administration (TGA), Australia -- PICMI (Product and Consumer Medicine Information) repository · Australia · accessed 2026-07-30 · source 7
- Medsafe search results referencing kanamycinMedsafe (New Zealand regulator) · New Zealand · accessed 2026-07-30 · source 8
Brand names by country
Single-ingredient kanamycin sulfate names are shown separately by country. Product availability, strengths, and supply rules can change; combination products are not included here.