toxylact: a07AA08 Kanamycin

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A07AA08 comprises oral kanamycin, an aminoglycoside antibiotic used as a non‑absorbed intestinal anti‑infective in enteric infections; oral kanamycin is generally compatible with breastfeeding because maternal systemic exposure and milk transfer are expected to be minimal at usual doses.atcddd.fhi+6

Drug and ATC classification

Kanamycin is an aminoglycoside antibacterial agent with activity against a range of Gram‑negative and some Gram‑positive bacteria and is also used as an antitubercular drug in systemic formulations.kegg+1
Within the ATC system it is classified in subgroup A07AA (intestinal antibiotics) as A07AA08 for oral formulations used in the treatment of intestinal infections, with a defined daily dose of 3 g orally.atcddd.fhi+1
Other codes for kanamycin include J01GB04 for systemic use and S01AA24 for ophthalmic preparations, but only the oral intestinal products belong to A07AA08.kegg+1

Pharmacology and toxicology

Kanamycin, like other aminoglycosides, binds to bacterial 30S ribosomal subunits, disrupting protein synthesis and leading to bactericidal effects against susceptible organisms.kegg+1
When administered orally as an intestinal anti‑infective, kanamycin is poorly absorbed from the gastrointestinal tract, so most of the administered dose remains in the lumen and is excreted unchanged in the feces.atcddd.fhi
Systemic aminoglycoside therapy is associated with nephrotoxicity and ototoxicity, particularly at higher serum levels and in patients with renal impairment, but these toxicities are mainly relevant to parenteral use and are not expected with standard oral intestinal treatment in patients with normal gut mucosa.fda+2

Use in lactation

Poorly absorbed intestinal antibiotics such as oral kanamycin typically produce very low maternal plasma concentrations and therefore minimal transfer into breast milk.ncbi.nlm.nih+1
Given the limited systemic absorption after oral administration, milk levels of kanamycin are expected to be extremely low, and clinically relevant exposure of the breastfed infant via milk is unlikely.atcddd.fhi+2
Consistent with lactation‑pharmacology principles, A07AA08 kanamycin is generally considered compatible with breastfeeding, and lactation can usually continue without interruption while monitoring the infant for nonspecific gastrointestinal effects such as diarrhoea, flatulence, or altered stool flora.ncbi.nlm.nih+2

Clinical considerations in breastfeeding women

Clinicians should confirm that the preparation used in a breastfeeding woman is an oral intestinal formulation (A07AA08) rather than a systemic aminoglycoside, as systemic therapy involves higher risks of maternal nephro‑ and ototoxicity and potentially greater milk transfer.atcddd.fhi+2
Standard precautions apply: use the lowest effective dose for the shortest necessary duration, consider maternal renal function, and avoid concomitant nephrotoxic drugs when any systemic absorption is possible.ncbi.nlm.nih+1
Major breastfeeding guidance emphasizes that most maternal medications, including many antibiotics, do not reach hazardous levels in breast milk and should be evaluated individually using specialized lactation resources such as LactMed, professional databases, and expert hotlines

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