The article reviews the physics related to kaon and antikaon production in heavy ion reactions at intermediate energies. Chiral dynamics predicts substantial modifications of the kaon properties in a dense nuclear environment. The status of the theoretical predictions as well as experimental evidences for medium effects such as repulsive/attractive mass shifts for K + /K − are reviewed. In the vicinity of the thresholds, and even more pronounced below threshold, the production of strangeness is a highly collective process. Starting from elementary reaction channels the phenomenology of K + and K − production, i.e. freeze-out densities, time scales etc. as derived from experiment and theoretical transport calculations is presented. Below threshold kaon production shows a high sensitivity on the nuclear compression reached in heavy ion reactions. This allows to put constraints on the nuclear equation-of-state which are finally discussed.