[3] It has the weakest antibacterial capabilities of all compounds in this family when used clinically, which is partially due to its increased toxicity in comparison to other aminoglycosides.

In cases of serious infection when the causative organism is unknown, Kanamycin injection in conjunction with a penicillin- or cephalosporin-type drug may be given initially before obtaining results of susceptibility testing.

[10] Kanamycin should be used with caution in newborns due to the risk of increased drug concentration resulting from immature kidney function.

[9] Serious side effects include ringing in the ears or loss of hearing, toxicity to kidneys, and allergic reactions to the drug.

This results in incorrect alignment with the mRNA and eventually leads to a misread that causes the wrong amino acid to be placed into the peptide.

This is due in part to possible cross-resistance between kanamycin and other aminoglycosides, such as amikacin, capreomycin, and gentamicin.

[17] The effects of these components do not appear to be widely studied as individual compounds when used against prokaryotic and eukaryotic cells.

At this point the kanamycin pathway splits into two branches due to the promiscuity of the next enzyme, which can utilize two different glycosyl donors - UDP-N-acetyl-α-D-glucosamine and UDP-α-D-glucose.

[citation needed] The selection marker kanMX is a hybrid gene consisting of a bacterial aminoglycoside phosphotransferase (kanr from transposon Tn903) under control of the strong TEF promoter from Ashbya gossypii.

[21][22] Mammalian cells, yeast, and other eukaryotes acquire resistance to geneticin (= G418, an aminoglycoside antibiotic similar to kanamycin) when transformed with a kanMX marker.

They primarily differ by additional restriction sites and other small changes around the actual open reading frame.