Neomycin
Mechanism :
Neomycin is an aminoglycoside antibiotic used topically to treat superficial infections of the skin and prevent infections due to burns, wounds and ulcers. It is also used to disinfect the bowel in hepatic encephalopathy.
Indication :
- Topical uses: include treatment for superficial eye infections, otitis externa, bacterial infections in skin, continuous short-term irrigant or rinse to prevent bacteriuria and gram-negative rod bacteremia in abacteriuric patients with indwelling catheters.
- Orally: For treatment of diarrhoea, hepatic encephalopathy, bowel preparation.
Contraindications :
Hypersensitivity, GI obstruction.
Dosing :
Neonates:
Diarrhea:
50 mg/kg/day PO in 4 divided doses.
Children:
Hepatic encephalopathy:
50-100 mg/kg/day PO in 3 divided doses for 5-6 days. Max: 12 g per day.
Bowel preparation:
90 mg/kg/day PO in 6 divided doses for 2-3 days.
Diarrhoea caused by enteropathogenic E.coli: 50 mg/kg/day PO in 4 divided doses for 2-3 days.
Otitis externa:
>2 years: 3 drops (0.5%) in each ear 3-4 times a day for 10 days.
Bacterial infections of the skin:
Apply 0.5% cream 2-3 times a day for 7 days.
For ulcers, lacerations, accidental cuts, scratches and abrasions: A thin layer of powder (3400 units) should be applied one to three times daily, depending on the clinical condition.
Adverse Effect :
Nephrotoxicity and ototoxicity if absorbed. Rash may be seen with topical application. Abdominal cramps, diarrhea, nausea/vomiting, irritation or soreness of mouth on oral intake.
Interaction :
Cefotaxime: Increased risk of nephrotoxicity.
Cefotetan: Increased risk of nephrotoxicity.
Cefoxitin: Increased risk of nephrotoxicity.
Ceftazidime: Increased risk of nephrotoxicity.
Ceftriaxone: Increased risk of nephrotoxicity.
Colistimethate: Aminoglycosides may enhance the nephrotoxic effect of Colistimethate. Aminoglycosides may enhance the neuromuscular-blocking effect of Colistimethate. Due to the potential for additive or synergistic toxicities (including both nephrotoxicity and neuromuscular blockade) between colistimethate and the aminoglycoside antibiotics, this combination should be avoided whenever possible. If these agents must be used together, patients renal and neuromuscular function should be monitored closely.
Tacrolimus: Additive renal impairment may occur during concomitant therapy with aminoglycosides such as Neomycin. Use caution during concomitant therapy.
Ticarcillin: Ticarcillin may reduce the serum concentration of Neomycin. Ticarcillin may inactivate Neomycin in vitro and the two agents should not be administered simultaneously through the same IV line.
Renal Dose :
Dose in Renal Impairment GFR (mL/min)
| 20-50 | Dose as in normal renal function. Use with caution and monitor renal function |
| 10-20 | Dose as in normal renal function. Use with caution and monitor renal function |
| <10 | Dose as in normal renal function. Use with caution and monitor renal function |
Dose in Patients undergoing Renal Replacement Therapies
| CAPD | Dialysed. Dose as in GFR<10 mL/ min |
| HD | Dialysed. Dose as in GFR<10 mL/ min |
| HDF/High flux | Dialysed. Dose as in GFR<10 mL/ min |
| CAV/VVHD | Dialysed. Dose as in GFR=10– 20 mL/min |
Hepatic Dose :
No dose adjustments are recommended. Use with caution in patients with severe hepatic impairment as it may precipitate hepato-renal syndrome.