Kanamycin
| Evidence Level: L5 | Predicted Indications: 10 |
Table of Contents
Kanamycin: From Urinary Tract Infection to Gonococcal Urethritis
One-Sentence Summary
Kanamycin is an aminoglycoside antibiotic, originally used for bacterial infections such as urinary tract infection, bacterial pneumonia and meningitis. For this report, the top-scoring TxGNN prediction (hyperamylasemia) has no supporting evidence, so we also assessed the best-supported prediction, gonococcal urethritis. It has no registered clinical trials and 19 publications, mostly historical (1958-2018), and several are indirect (susceptibility surveillance or other drugs).
Quick Overview
| Item | Content |
|---|---|
| Original Indication | Urinary tract infection, bacterial pneumonia, cholangitis, bacterial arthritis, meningitis (from the knowledge graph; the Singapore licence records contain no indication text) |
| Predicted New Indication | Top-ranked prediction: hyperamylasemia (no evidence). Best-supported prediction: gonococcal urethritis (rank 5) |
| TxGNN Prediction Score | Hyperamylasemia 94.53%; gonococcal urethritis 92.88% |
| Evidence Level | Hyperamylasemia L5; gonococcal urethritis L3 |
| Singapore Market Status | ✓ Marketed |
| Number of Registrations | 2 |
| Recommended Decision | Hold (overall); gonococcal urethritis is a research question only |
Why is This Prediction Reasonable?
Detailed mechanism-of-action data is not available in the data compiled for this report. Kanamycin is known to be an aminoglycoside that inhibits bacterial protein synthesis through the 30S ribosomal subunit, which is bactericidal against susceptible organisms.
Top-ranked predictions. Most of the top 10 predictions have no plausible mechanistic link to an antibacterial drug. These are hyperamylasemia, polyclonal hyperviscosity syndrome, congenital analbuminemia, premalignant hematological system disease and monoclonal gammopathy. Their high scores appear to be knowledge-graph artefacts. "Blood group incompatibility" matched only an unrelated paper on bacterial plasmid incompatibility, a keyword false positive.
Gonococcal urethritis. This is the only prediction with a credible rationale and a meaningful body of literature. Kanamycin is active against Neisseria gonorrhoeae, and the indication is close to the original urinary tract infection use, so it is not a truly novel repurposing target. Current gonorrhoea management favours ceftriaxone-based regimens because of widespread resistance, so any renewed interest is limited to niche, resistance-guided or resource-limited settings.
Other infectious predictions. Ureaplasma urethritis, uterine inflammatory disease and xanthogranulomatous pyelonephritis have theoretical antibacterial rationales but weak or no evidence. Ureaplasma lacks a cell wall and is generally poorly susceptible to aminoglycosides. Xanthogranulomatous pyelonephritis is usually managed surgically.
Clinical Trial Evidence
Currently no related clinical trials registered.
Literature Evidence
Gonococcal urethritis (selected from 19 publications; evidence is based on titles and abstracts, and full texts were not reviewed):
| PMID | Year | Type | Journal | Key Findings |
|---|---|---|---|---|
| 3890228 | 1985 | Open clinical trial | Sex Transm Dis | Single-dose gentamicin (280 mg) vs kanamycin (2 g) IM in uncomplicated gonococcal urethritis in Zambia, during a rise in penicillinase-producing gonococci |
| 6428699 | 1984 | Clinical study | Br J Vener Dis | Two-dose Augmentin cured 95.9% vs 87.4% with single-dose kanamycin 2 g IM in 192 men |
| 6672557 | 1983 | Clinical study | Med J Malaysia | Kanamycin in male gonococcal urethritis (no abstract available) |
| 813568 | 1975 | Clinical study | Antibiotiki | Kanamycin and vibramycin in gonorrhoea in 112 and 86 men; recovery 85.6% and 92.9% respectively |
| 19556927 | 2009 | Susceptibility study | Sex Transm Dis | Susceptibility of gonococcal isolates in Maputo, aimed at assessing kanamycin effectiveness |
| 2672256 | 1989 | Review | Rev Infect Dis | Notes emerging bacterial resistance to kanamycin in Hong Kong; quinolones then replaced older agents |
| 13637839 | 1958 | Preliminary report | Antibiotics Annual | IM kanamycin in acute male gonococcal urethritis (no abstract available) |
Ureaplasma urethritis:
| PMID | Year | Type | Journal | Key Findings |
|---|---|---|---|---|
| 34136 | 1978 | Antibiogram article | Pathol Biol | Kanamycin among the antibiotics active in vitro, but ranked below minocycline, pristinamycin and erythromycin; susceptibility data only |
No literature was found for the other top-ranked predictions.
Singapore Market Information
| Authorization Number | Product Name | Dosage Form | Approved Indication |
|---|---|---|---|
| SIN02356P | KANAMYCIN MEIJI FOR INJECTION 1 g/vial | Injection, powder, for solution | Not stated in the available records |
| SIN01963P | KANAMYCIN SULFATE INJECTION 1 g/3 ml | Injection | Not stated in the available records |
Both licences are valid single-ingredient injectable products from Thai Meiji Pharmaceutical.
Safety Considerations
Package insert warnings and contraindications were not available. Please refer to the package insert for safety information.
- Contraindication signals from the knowledge graph (not label text): kidney disease, pyoureter, hypercalcemia, nephrocalcinosis, phosphorus metabolism disease, central nervous system origin vertigo, myasthenia gravis, neuromuscular junction disease, and Parkinson disease or parkinsonian disorders.
- Drug interactions (100 recorded; selected):
- Major: botulinum toxin type A, intravenous human immunoglobulin G, bacitracin.
- Moderate: amphotericin B (including lipid complex), amikacin, neomycin (topical), ampicillin, NSAIDs (ketorolac, ibuprofen, celecoxib, aspirin), bisphosphonates (alendronic acid, risedronic acid), oestrogens, rabeprazole, and mesalazine and balsalazide.
- Minor: lidocaine.
Combinations with other nephrotoxic, ototoxic or neuromuscular-blocking agents warrant particular care.
Conclusion and Next Steps
Decision: Hold
Rationale: The top-ranked predictions lack any mechanistic or clinical support and appear to be graph artefacts. The best-supported candidate, gonococcal urethritis, rests on old, small, non-modern studies. It overlaps with the original anti-infective use, and resistance and current guidelines favour other agents. It is a research question rather than a repurposing opportunity ready to proceed.
To proceed, the following is needed:
- Package insert warnings and contraindications from the HSA (a blocking gap for safety screening)
- Mechanism-of-action data from DrugBank
- Current local gonococcal resistance data to kanamycin, and comparison with guideline regimens
- Full-text review of the key gonococcal urethritis studies
- A renal, auditory and neuromuscular safety assessment for any new use
Disclaimer
This content is for research purposes only and does not constitute medical advice. Clinical validation is required before any clinical application.