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neomycin

S01AA03

Forms & Strengths

Ophthalmic solution 0.5% and 1%
Otic solution 0.1% and 0.5%
Oral powder 500 mg/g (non‑absorbable)
Topical cream/ointment 0.5%

Adult Dosing

Ophthalmic: 1–2 drops into conjunctival sac every 4–6 h while awake
Otic: 5 drops 2–3 times daily for 7 days (no perforated tympanic membrane)
Intestinal decontamination: 5 g orally single dose, repeat after 6 h if needed
Pre‑operative bowel prep: 10 g orally divided q12 h

Pediatric Dosing

Ophthalmic: 1 drop q4–6 h; neonates may use 0.5 drop
Otic: same as adult; contraindicated if tympanic membrane perforated
Intestinal decontamination: 2.5 g (<40 kg) single dose, repeat after 6 h
Systemic use not recommended in neonates

Indications

Bacterial conjunctivitis and corneal ulcers (Gram‑negative organisms)
Acute otitis externa (topical)
Pre‑operative intestinal decontamination
Treatment of hepatic encephalopathy (oral non‑absorbable)
Adjunct in bowel preparation for colonoscopy

Mechanism of Action

Aminoglycoside that binds the 30S ribosomal subunit
Inhibits initiation complex formation and causes misreading of mRNA
Bactericidal against aerobic gram‑negative bacilli

Contraindications

Known hypersensitivity to neomycin or other aminoglycosides
Otic formulation in patients with perforated tympanic membrane
Severe renal impairment for systemic use
Pregnancy: avoid systemic use unless benefit outweighs risk

Adverse Reactions

Local irritation, burning or stinging (ocular/otic)
Allergic contact dermatitis (topical)
Nephrotoxicity (systemic, especially with high doses)
Ototoxicity (cochlear and vestibular) with otic or systemic exposure
Hearing loss, tinnitus, vertigo

Drug Interactions

Increased nephrotoxicity with loop diuretics, vancomycin, amphotericin B
Additive ototoxicity with other aminoglycosides or furosemide
Reduced effect of neuromuscular blocking agents
Antagonism with bacteriostatic antibiotics (e.g., chloramphenicol, tetracyclines)
Potential decreased renal clearance when combined with NSAIDs

Curated Content: Needs Vetting Before Put to Clinical Use