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neomycin

A01AB08

Forms & Strengths

Oral tablet: 500 mg
Topical cream: 0.5%
Topical ointment: 0.5%
Ophthalmic solution: 0.35%
Ophthalmic ointment: 0.35%

Adult Dosing

Hepatic encephalopathy (oral): 4 g to 12 g daily in divided doses for 5 to 6 days
Bowel preparation (oral): 1 g co-administered with erythromycin base before surgery
Topical skin infections: Apply small amount 1 to 4 times daily
Ophthalmic infections: 1 to 2 drops or small ribbon of ointment every 3 to 4 hours

Pediatric Dosing

Hepatic encephalopathy (oral, children > 1 month): 50 to 100 mg/kg/day in divided doses every 6 hours
Bowel preparation (oral, children): 90 mg/kg/day divided every 4 hours for 2 days
Topical/Ophthalmic (infants and children): Apply small amount 1 to 4 times daily

Indications

Suppression of intestinal microflora prior to colorectal surgery
Adjunctive therapy in hepatic coma (hepatic encephalopathy)
Treatment of minor superficial skin infections
Treatment of superficial ocular infections caused by susceptible organisms

Mechanism of Action

Aminoglycoside antibiotic that binds irreversibly to the 30S ribosomal subunit of susceptible bacteria
Inhibits bacterial protein synthesis and misreads the genetic code, leading to cell death
Poorly absorbed from the gastrointestinal tract, providing local antibacterial action in the bowel lumen

Contraindications

Hypersensitivity to neomycin or other aminoglycosides
Intestinal obstruction (for oral formulations)
Pre-existing systemic nephrotoxicity or ototoxicity (when significant systemic absorption is possible)
Use in deep puncture wounds or severe burns (topical)

Adverse Reactions

Nephrotoxicity and ototoxicity (primarily with systemic absorption or prolonged use)
Contact dermatitis and allergic hypersensitivity reactions (common with topical use)
Neuromuscular blockade and respiratory paralysis (associated with large systemic doses or peritoneal lavage)
Nausea, vomiting, and diarrhea (oral administration)
Superinfection and overgrowth of non-susceptible organisms (e.g., fungi, C. difficile)

Drug Interactions

Potentiation of nephrotoxicity and ototoxicity with concurrent use of other aminoglycosides, vancomycin, amphotericin B, or loop diuretics
Enhancement of neuromuscular blockade when combined with neuromuscular blocking agents or general anesthetics
Potential decrease in absorption of digoxin and oral vitamin B12 with oral neomycin
Potential decreased efficacy of oral live vaccines due to antibacterial activity

Curated Content: Needs Vetting Before Put to Clinical Use