What this test measures
This test determines whether a cultured M. tuberculosis isolate is sensitive or resistant to kanamycin at the WHO-defined critical concentration. Kanamycin is an aminoglycoside injectable that historically formed the backbone of second-line MDR-TB regimens. Resistance is most often due to mutations in the rrs gene (a1401g) which confer cross-resistance with amikacin and capreomycin.
Why it matters
Kanamycin use has declined sharply since WHO and NTEP moved to all-oral MDR-TB regimens with bedaquiline, linezolid and pretomanid. Kanamycin DST is still relevant for:
- Surveillance of injectable resistance across India. - Salvage regimens when other options are exhausted. - Patients on legacy regimens or those whose treatment is failing.
Kanamycin has ototoxic and nephrotoxic side effects similar to other aminoglycosides; audiometry and creatinine monitoring are essential when it is used.
How to prepare
A positive M. tuberculosis culture (MGIT or LJ) is required. If not available, sputum samples must be collected for AFB culture first.
Markers & reference ranges
Reference ranges below are typical adult values. Your lab's reported range may differ slightly based on the assay platform and patient demographics — always read your report against the range printed on it.
Injectable aminoglycosides — when each is preferred
| Drug | Preference today | Reason |
|---|---|---|
| Amikacin | Preferred if injectable needed | Better tolerability data |
| Capreomycin | Alternative | Cyclic peptide; cross-resistance with Km/Am |
| Kanamycin | Largely phased out | Toxicity, all-oral regimen availability |
| Streptomycin | First-line only (rarely used) | Older aminoglycoside |
Frequently asked questions
Is kanamycin still used in MDR-TB?
Rarely. WHO and NTEP have moved to all-oral regimens. Kanamycin is reserved for salvage cases where other options are not available.
What are the major side effects?
Hearing loss, balance problems, kidney injury. Audiometry and creatinine are monitored throughout treatment.
If I am resistant to kanamycin, am I resistant to amikacin?
Usually yes — both are aminoglycosides and the rrs a1401g mutation confers cross-resistance with capreomycin too.
How long does the test take?
About 1–2 weeks from a positive culture; 4–6 weeks total from sputum collection.
Is the test available under NTEP?
Yes — second-line DST is provided at NTEP intermediate and national reference labs. Private NABL-accredited labs also offer it.
Why is kanamycin still tested if it is rarely used?
Surveillance of injectable resistance is still important, and a small number of patients still receive injectables in specific situations.
Is kanamycin used outside TB?
Kanamycin has limited clinical use outside TB in modern practice due to its toxicity. Other aminoglycosides (amikacin, gentamicin) are preferred for general gram-negative infections.
Related Tuberculosis / Mycobacterial tests
Tests commonly ordered alongside ANTIBIOGRAM - MTB (KANAMYCIN), or that help interpret an unexpected result.
Sources & references
- WHO Consolidated Guidelines on Drug-Resistant TB · accessed 2026-05-30T00:00:00.000Z
- NTEP PMDT Guidelines · accessed 2026-05-30T00:00:00.000Z
- India TB Report 2024 · accessed 2026-05-30T00:00:00.000Z
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