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neomycin, combinations

A07AA51

Forms & Strengths

Neomycin sulfate 300,000 units / Polymyxin B sulfate / Bacitracin zinc topical ointment
Neomycin sulfate / Polymyxin B sulfate / Hydrocortisone otic suspension (1% / 10,000 units / 0.5%)
Neomycin sulfate 500 mg oral tablets (often combined with kaolin, pectin, or enteric anti-infectives)

Adult Dosing

Topical: Apply a small amount to the affected area 1 to 3 times daily
Otic: 4 drops in the affected ear 3 to 4 times daily
Oral (Hepatic Encephalopathy): 4 to 12 g daily in divided doses for 5 to 6 days
Oral (Bowel Sterilization): 1 g every hour for 4 doses, then 1 g every 4 hours for 24 to 48 hours preoperatively

Pediatric Dosing

Topical (Children > 2 years): Apply a small amount 1 to 3 times daily
Otic (Children > 2 years): 3 drops in the affected ear 3 to 4 times daily
Oral (Hepatic Encephalopathy / Infrequently used): 50 to 100 mg/kg/day in divided doses every 6 hours

Indications

Treatment of minor skin cuts, scrapes, and burns to prevent infection (topical)
Treatment of superficial bacterial infections of the external auditory canal (otic)
Adjunctive management of hepatic encephalopathy to reduce ammonia-producing bacteria
Preoperative intestinal antisepsis

Mechanism of Action

Aminoglycoside antibiotic that binds irreversibly to the 30S ribosomal subunit of susceptible bacteria
Inhibits bacterial protein synthesis and misreads genetic code, leading to cell death
Broad-spectrum bactericidal activity primarily against gram-negative bacilli and some gram-positive organisms

Contraindications

Hypersensitivity to neomycin or other aminoglycosides
Perforated tympanic membrane (for otic preparations containing neomycin)
Fungal, viral, or mycobacterial skin infections (for topical preparations)
Systemic administration due to severe risk of nephrotoxicity and ototoxicity

Adverse Reactions

Allergic contact dermatitis, skin sensitization, and pruritus (common with topical use)
Ototoxicity (vestibular and cochlear damage) with prolonged or systemic absorption
Nephrotoxicity with significant systemic absorption
Superinfection and overgrowth of nonsusceptible organisms with prolonged use

Drug Interactions

Concomitant use with systemic aminoglycosides increases risk of cumulative ototoxicity and nephrotoxicity
May enhance the neuromuscular blocking effects of skeletal muscle relaxants
Potentiation of nephrotoxic drugs such as amphotericin B, vancomycin, and potent diuretics (e.g., furosemide)
May decrease absorption of oral Vitamin B12

Curated Content: Needs Vetting Before Put to Clinical Use