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neomycin

S02AA07

Forms & Strengths

Ophthalmic solution 0.5% (1 g/200 mL)
Otic suspension 0.1% (1 g/1 L)
Topical cream 0.5% w/w
Topical ointment 0.5% w/w
Oral tablets 500 mg
Oral suspension 250 mg/5 mL

Adult Dosing

Ophthalmic: 1‑2 drops q4‑6h in affected eye
Otic: 3‑4 drops q8h for 7‑10 days (intact tympanic membrane)
Skin: apply thin layer q6‑8h for up to 7 days
Oral bowel decontamination (pre‑op): 1 g PO q6h for 3 days
Hepatic encephalopathy: 1 g PO q8h until stool sterility achieved

Pediatric Dosing

Ophthalmic: 1 drop per eye q6h (infants) or 1‑2 drops q4‑6h (children)
Otic: 2‑3 drops q8h (age > 6 months, intact drum)
Skin: thin layer q8h; max 0.5 g/kg/day
Oral bowel decontamination: 10‑20 mg/kg/dose PO q6h (max 2 g/day)
Hepatic encephalopathy: 10‑15 mg/kg PO q8h (max 1 g/dose)

Indications

Bacterial conjunctivitis (Gram‑negative)
Otitis externa (topical)
Superficial skin infections and wound prophylaxis
Pre‑operative bowel decontamination
Prevention/treatment of hepatic encephalopathy
Prophylaxis of spontaneous bacterial peritonitis in cirrhosis

Mechanism of Action

Aminoglycoside that binds the 30S ribosomal subunit
Causes misreading of mRNA and inhibition of initiation complex
Bactericidal against aerobic Gram‑negative organisms (Pseudomonas, E.coli, Klebsiella)

Contraindications

Known hypersensitivity to neomycin or other aminoglycosides
Perforated tympanic membrane or mastoiditis (otitis externa)
Severe renal impairment for systemic use
Neonates (systemic) and pregnant women only if benefit outweighs risk

Adverse Reactions

Ototoxicity (vestibular dysfunction, hearing loss) – systemic or otic use
Nephrotoxicity – systemic administration, especially with prolonged therapy
Local irritation, burning, itching at application site
Allergic contact dermatitis (topical)
Nausea, vomiting, diarrhea with oral use

Drug Interactions

Concurrent nephrotoxic agents (e.g., vancomycin, amphotericin B, loop diuretics) increase renal toxicity
Other ototoxic drugs (e.g., gentamicin, loop diuretics, cisplatin) potentiate hearing loss
Neuromuscular blocking agents may have prolonged effect
Muscle relaxants (e.g., dantrolene) can enhance neuromuscular blockade
May increase serum creatinine without true renal injury, affecting lab interpretation

Curated Content: Needs Vetting Before Put to Clinical Use