Neomycin and polymyxin B (Maxitrol) is a combination of non-absorbable antibiotics that are used for bladder irrigation in patients who develop bacteriuria due to prolonged bladder catheterization.
Neomycin and polymyxin B (Maxitrol) Uses:
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Urinary bladder irrigant:
- It is used as a bladder irrigant (for short-term use of up to 10 days) in patients who have bacteriuria due to the use of long-term indwelling catheters to prevent bacteria and septicemia.
Neomycin and polymyxin B (Maxitrol) Dose in Adults
Neomycin and polymyxin B Dose in the treatment of Urinary bladder irrigant:
- Intravesical:
- Add 1 mL irrigant to 1,000 ml isotonic saline solution per day as continuous irrigation for up to 10 days.
Neomycin and polymyxin B (Maxitrol) Dose in Children
Neomycin and polymyxin B Dose in the treatment of Urinary bladder irrigant:
Note: The data is limited and the effectiveness of the drug varies. Most of the experience with the drug has been in patients with spinal cord injury or neurogenic bladder.
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Children and Adolescents:
- Irrigant solution (neomycin 40 mg/polymyxin B 200,000 units/L):
- Intravesical: 10 mL instilled at the end of each catheterization and retained until next catheterization.
- In older adolescents, 30 mL 2 to 3 times daily has been used for asymptomatic bacteriuria.
- Note: Use has generally been replaced with other agents (eg, saline, gentamicin).
- Irrigant solution (neomycin 40 mg/polymyxin B 200,000 units/L):
Pregnancy Category: C
- Studies on animal reproduction have not been carried out using this mixture.
- There are reports of total irreversible bilateral congenital deafness in children whose mothers received streptomycin during pregnancy.
- Talk to individual agents.
Use during breastfeeding:
- The drug's potential for excretion into breastmilk is unknown.
Dose in Kidney Disease:
The manufacturer has not recommended any adjustments in the dose in patients with kidney disease.
Dose in Liver disease:
The manufacturer has not recommended any adjustments in the dose in liver disease.
Side effects of Neomycin and polymyxin B (Maxitrol):
-
Central Nervous System:
- Localized Burning
-
Dermatologic:
- Contact Dermatitis
- Erythema
- Skin Rash
- Urticaria
-
Genitourinary:
- Bladder Mucosa Irritation
- Nephrotoxicity
-
Neuromuscular & Skeletal:
- Neuromuscular Blockade
-
Otic:
- Ototoxicity
Contraindications to Neomycin and polymyxin B (Maxitrol):
- Neomycin, neomycin B, or any other ingredient of the formulation-related allergic responses
- those who have previously experienced severe allergic responses to aminoglycosides.
Warnings and precautions
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Superinfection
- Long-term use of the drug can lead to fungal and bacterial superinfections, such as C. difficile-associated diarrhea or pseudomembranous collitis.
- CDAD can occur even after two months of last antibiotic use.
-
Systemic toxicities:
- Systemic absorption may lead to nephrotoxicity, ototoxicity, or neuromuscular blockade.
- Systemic absorption can be more common in patients who have bladder defects or who have had surgery that has caused injury to the bladder wall.
-
Renal impairment
- It can increase the risk of kidney toxicity. You should use it with caution.
Neomycin and polymyxin B: Drug Interaction
|
Risk Factor C (Monitor therapy) |
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Acarbose |
Neomycin may enhance the adverse/toxic effect of Acarbose. Neomycin may decrease the metabolism of Acarbose. |
|
Amphotericin B |
Aminoglycosides' nephrotoxic effects might be amplified. |
|
Arbekacin |
Aminoglycosides' nephrotoxic effects might be amplified. Arbekacin may make aminoglycosides more ototoxic. |
|
BCG Vaccine (Immunization) |
Antibiotics may reduce the BCG vaccine's therapeutic effect (Immunization). |
|
Bisphosphonate Derivatives |
The hypocalcemic action of bisphosphonate derivatives may be enhanced by aminoglycosides. |
|
Botulinum Toxin-Containing Products |
The neuromuscularblocking action of products containing botulinum toxin may be enhanced by aminoglycosides. |
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Capreomycin |
May strengthen Polymyxin B's ability to impede neuromuscular transmission. |
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CARBOplatin |
Aminoglycosides may increase CARBOplatin's ototoxic effects. especially when carboplatin doses are higher. |
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Cardiac Glycosides |
Cardiac Glycosides' serum levels may be lowered by aminoglycosides. Only oral aminoglycoside treatment has proven to have this effect. |
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Cefazedone |
May intensify Polymyxin B's nephrotoxic effects. |
|
Cephalosporins (2nd Generation) |
Aminoglycosides' nephrotoxic effects might be amplified. |
|
Cephalosporins (3rd Generation) |
Aminoglycosides' nephrotoxic effects might be amplified. |
|
Cephalosporins (4th Generation) |
Aminoglycosides' nephrotoxic effects might be amplified. |
|
Cephalothin |
Aminoglycosides' nephrotoxic effects might be amplified. |
|
Cephradine |
Aminoglycosides' nephrotoxic effects might be amplified. |
|
CISplatin |
Aminoglycosides' nephrotoxic effects might be amplified. |
|
CycloSPORINE (Systemic) |
Aminoglycosides may increase CycloSPORINE's nephrotoxic effects (Systemic). |
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Distigmine |
Aminoglycosides may reduce Distigmine's therapeutic efficacy. |
|
Lactobacillus and Estriol |
The therapeutic effects of Lactobacillus and Estriol may be reduced by antibiotics. |
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Loop Diuretics |
Aminoglycosides' harmful or poisonous effects could be amplified. ototoxicity and nephrotoxicity in particular. |
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Nonsteroidal Anti-Inflammatory Agents |
Aminoglycosides' excretion may be reduced. only information on preterm newborns. |
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Oxatomide |
Aminoglycosides' nephrotoxic effects might be amplified. |
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Regorafenib |
The active metabolite(s) of Regorafenib's serum concentrations may be lowered by neomycin. |
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SORAfenib |
It's possible that neomycin will lower SORAfenib's serum levels. |
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Tenofovir Products |
Tenofovir products' serum concentration may be raised by aminoglycosides. Aminoglycoside content in the serum may rise as a result of using tenofovir products. |
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Vancomycin |
Aminoglycosides' nephrotoxic effects might be amplified. |
|
Vitamin K Antagonists (eg, warfarin) |
The anticoagulant action of Vitamin K antagonists may be enhanced by neomycin. |
|
Risk Factor D (Consider therapy modification) |
|
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Colistimethate |
Colistimethate's nephrotoxic action may be increased by aminoglycosides. Colistimethate's ability to suppress neuromuscular activity may be improved by aminoglycosides. |
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Neuromuscular-Blocking Agents |
The neuromuscular-blocking effects of neuromuscular-blocking agents may be strengthened by polymyxin B. |
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Penicillins |
Aminoglycosides' serum levels could drop. mainly found in patients with renal impairment and extended spectrum penicillins. Penicillin G (Parenteral/Aqueous); Penicillin G Benzathine; Penicillin G Procaine; Penicillin V Benzathine; Penicillin V Potassium; are exceptions to this rule. Other exceptions are Amoxicillin, Ampicillin, Bacampicillin, Cloxacillin, Dicloxacillin, Nafcillin, and Oxacillin. |
|
Sodium Picosulfate |
Antibiotics may reduce Sodium Picosulfate's therapeutic impact. Management: If a patient previously used or is currently using an antibiotic, think about utilising an alternative product for bowel cleansing prior to a colonoscopy. |
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Risk Factor X (Avoid combination) |
|
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Ataluren |
Aminoglycosides' harmful or poisonous effects could be amplified. Specifically, using ataluren and aminoglycosides simultaneously may result in an elevated risk of nephrotoxicity. |
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Bacitracin (Systemic) |
Polymyxin B may increase Bacitracin's nephrotoxic effects (Systemic). |
|
Bacitracin (Systemic) |
Neomycin may intensify Bacitracin's nephrotoxic effects (Systemic). |
|
BCG (Intravesical) |
Antibiotics may lessen BCG's therapeutic effects (Intravesical). |
|
Cholera Vaccine |
Antibiotics may diminish the therapeutic effect of Cholera Vaccine. Management: Avoid cholera vaccine in patients receiving systemic antibiotics, and within 14 days following the use of oral or parenteral antibiotics. |
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Foscarnet |
Aminoglycosides' nephrotoxic effects might be amplified. |
|
Mannitol (Systemic) |
Aminoglycosides' nephrotoxic effects might be amplified. |
|
Mecamylamine |
Mecamylamine's ability to suppress neuromuscular activity could be improved by polymyxin B. |
|
Methoxyflurane |
May intensify Polymyxin B's nephrotoxic effects |
Monitoring parameters:
- Urinalysis,
- renal function.
How to administer Neomycin and polymyxin B?
- It is indicated only for the irrigation of the bladder and not for parenteral administration.
- The inflow lumen of the 3-way catheter should be connected to the irrigation container to allow the continuous irrigation of the urinary bladder.
- The bladder rinse should be continuous and the irrigation should not be interrupted for more than a few minutes.
- The flow rate of the irrigation should be adjusted to 1 liter per 24 hours.
- However, if the patients' urine output exceeds 2 liters per 24 hours, the flow rate should be set at a rate of 2 liters per 24 hours.
Mechanism of action of Neomycin and polymyxin B:
Neomycin:
- It binds with the 30S subunit of the ribosomal ribosomal subunit, inhibits bacterial protein synthesis, and indirectly inhibits bacterial replication.
Polymyxin B
- By binding to phospholipids, it damages the bacterial cell membrane. It causes a decrease in bacterial cellular permeability, which allows for the leakage intracellular content.
Talk to individual agents.
Absorption:
- It is only minimally absorbed when used topically. Systemic absorption can occur if the bladder is inflamed or denuded.
International Brands of Neomycin and polymyxin B:
- Neosporin G.U. Irrigant
- Neosporin Irrigating Solution
- Alosol
- Isopto Statrol
- Maxitrol
- Statrol
Neomycin and polymyxin B Brands Names in Pakistan:
- Maxitrol
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