Neomycin is a non-absorbable antibiotic of the aminoglycoside group. It is mostly used as a topical preparation, however, it is also used orally for bacterial overgrowth and bacterial eradication.
Indications of Neomycin:
-
Hepatic coma (portal-systemic encephalopathy):
- It is used as a combination therapy in hepatic coma.
-
Perioperative prophylaxis:
- It is administered in combination with enteric-coated erythromycin to suppress the usual bacterial flora in the bowels.
Neomycin dose in adults:
Neomycin dose in the perioperative prophylaxis:
- 1g per oral at 1 PM, 2 PM, and 11 PM on the day preceding 8 AM surgery in addition to oral erythromycin for cleansing (manufacturer’s labeling) or in alternatively in combination with erythromycin/metronidazole and intravenous antibiotics on the day of surgery.
Neomycin dose in the treatment of Hepatic encephalopathy:
- For five to six days, take 4 to 12 g orally split every four to six hours.
Neomycin dose in the treatment of Chronic hepatic insufficiency:
- 4 g per oral daily for an indefinite period
Neomycin dose in children:
Note: Dosage is expressed in terms of neomycin sulfate.
Neomycin dose for the prophylactic treatment of recurrent cholangitis after Kasai porto-enterostomy:
- To the age of two to three years old, 25 to 50 mg/kg per mouth per day in four divided doses, four days per week.
Treatment dose in the Enteric bacteria eradication (including gut flora)/ infection:
- 50 to 100 mg/kg orally, split every 6 to 8 hours, per day
- The daily dosing cap is 12 g.
- Treatment duration should not be more than 2 weeks due to systemic toxicity.
Neomycin dose for the treatment of Hepatic encephalopathy:
- For a week, administer 50 to 100 mg/kg orally, split into 6 hours, with or without lactulose.
- The maximum daily dose: 12 g/day
Treatment dose in the Preoperative intestinal antisepsis:
- Prior to surgery, take erythromycin or metronidazole concurrently with 15 mg/kg per oral for 3 doses spread out over 10 hours (for example, at 1 PM, 2 PM, and 11 PM), with or without mechanical intestinal cleansing.
- The maximum dose is 1,000 mg/dose
Pregnancy Risk Factor D
- It can cross placenta.
- Use of aminoglycosides during pregnancy can lead to irreversible bilateral congenital hearing loss in children.
- Higher doses of oral therapy may result in malabsorption of nutrients.
Neomycin use during breastfeeding:
- If the medication was absorbed into breast milk is unknown.
- Manufacturer recommends that you stop feeding/ Drug therapy is stopped depending on how important it is for the mother.
- The infant's bowel flora may be altered by antibiotic exposure.
Dose adjustment in renal disease:
- There are no dosage adjustments provided in manufacturer’s labeling.
- Patients with renal impairment are more likely to experience nephrotoxicity or ototoxicity; as a result, a dose decrease or withdrawal is required.
Dose adjustment in liver disease:
There are no dosage adjustments provided in manufacturer’s labeling.
Side Effects of Neomycin:
-
Central nervous system:
- Sore mouth
-
Gastrointestinal:
- Anorectal Pain
- Diarrhea
- Mouth Irritation
- Nausea
- Rectal Irritation
- Vomiting
Contraindication to Neomycin:
Among them is sensitivity to Neomycin or any other ingredient in the formulation. Colitis of the bowels blockage in the intestines
Warnings and precautions
-
Malabsorption
- In larger amounts, malabsorption of fats, Sodium and Iron, Vitamin B12, Vitamin B12, Vitamin B12, Vitamin B12, Nitrogen, Cholesterol, Carotene, Vitamin B12 and glucose can occur.
-
Nephrotoxicity: [US Boxed Warning]
- Dehydration, pre-existing kidney impairment, and a combination nephrotoxic medication are all risk factors for renal toxicities.
-
The US Boxed Warning: Neuromuscular Blockade and Respiratory Paralysis
- Dosing immediately after anesthesia or using other muscle relaxants could cause neuromuscular blockade or respiratory paralysis.
-
Neurotoxicity: [US Boxed Warn]
- You may experience symptoms such as numbness or skin tingling, muscle spasms, seizures, or other signs.
-
Superinfection
- Long-term medication may result in fungal or bacterial superinfection (C. difficile-associated diarrhea/pseudomembranous colitis).
-
Hearing impairment:
- Patients with hearing loss, vertigo, or tinnitus should be cautious.
-
Neuromuscular disorders:
- Patients with neuromuscular conditions like Parkinson's disease or myasthenia gravis should exercise caution.
-
Renal impairment
- Patients with pre-existing renal impairment need to be reduced in dosage
Neomycin: Drug Interaction
Risk Factor C (Monitor therapy) |
|
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. |
Capreomycin |
Aminoglycosides' capacity to inhibit neuromuscular transmission might be increased. |
CARBOplatin |
Aminoglycosides may increase CARBOplatin's ototoxic effects. especially when carboplatin doses are higher. |
Cardiac Glycosides |
Cardiac Glycosides' serum levels may be lowered by aminoglycosides. Only oral aminoglycoside treatment has proven to have this effect. |
Cefazedone |
Aminoglycosides' nephrotoxic effects might be amplified. |
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). |
Distigmine |
Aminoglycosides may reduce Distigmine's therapeutic efficacy. |
Lactobacillus and Estriol |
The therapeutic effects of Lactobacillus and Estriol may be reduced by antibiotics. |
Loop Diuretics |
Aminoglycosides' harmful or poisonous effects could be amplified. ototoxicity and nephrotoxicity in particular. |
Neuromuscular-Blocking Agents |
Neuromuscular-Blocking Agents' respiratory depressive action may be strengthened by aminoglycosides. |
Nonsteroidal Anti-Inflammatory Agents |
Aminoglycosides' excretion may be reduced. only information on preterm newborns. |
Oxatomide |
Aminoglycosides' ototoxic effects might be amplified. |
Regorafenib |
The active metabolite(s) of Regorafenib's serum concentrations may be lowered by neomycin. |
SORAfenib |
It's possible that neomycin will lower SORAfenib's serum levels. |
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. |
Vancomycin |
The nephrotoxic effects of aminoglycosides might be enhanced. |
Vitamin K Antagonists (eg, warfarin) |
The anticoagulant action of Vitamin K antagonists may be enhanced by neomycin. |
Risk Factor D (Consider therapy modification) |
|
Colistimethate |
Colistimethate's nephrotoxic action may be increased by aminoglycosides. Colistimethate's ability to suppress neuromuscular activity may be improved by aminoglycosides. |
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. |
Risk Factor X (Avoid combination) |
|
Ataluren |
Aminoglycosides' harmful or poisonous effects could be amplified. Specifically, using ataluren and aminoglycosides simultaneously may result in an elevated risk of nephrotoxicity. |
Bacitracin (Systemic) |
Neomycin may intensify Bacitracin's nephrotoxic effects (Systemic). |
BCG (Intravesical) |
Antibiotics may lessen BCG's therapeutic effects (Intravesical). |
Foscarnet |
Aminoglycosides' nephrotoxic effects might be amplified. |
Mannitol (Systemic) |
May enhance the nephrotoxic effect of Aminoglycosides. |
Mecamylamine |
Mecamylamine's ability to suppress neuromuscular activity may be improved by aminoglycosides. |
Methoxyflurane |
Methoxyflurane's nephrotoxic effects may be intensified by aminoglycosides. |
Monitoring parameters:
Monitoring is required for :
- Renal function tests (BUN and Creatinine)
- audiometry in symptomatic patients
How to administer Neomycin?
It should be given orally irrespective of food, Administration at prescribed dosing times is necessary in preoperative intestinal antisepsis.
Mechanism of action of Neomycin:
It acts by binding with 30S ribosomal Subunits, causing an interruption in bacterial protein synthesis
Absorptionis not recommended for subQ or oral administration.
Distribution97% of the orally administered dose is still in the gastrointestinal tract. Neomycin is absorbed into tissues and concentrated in the renal cortex. The inner ear can also accumulate if you take repeated doses.
Protein binding0% to 30%
Time required to reach peak serum concentration: 1 to 4 Hours
Excretion: Feces (97% oral dose as unchanged drugs); urine (30% to 50%) of absorbed drug is unchanged drugs
Neomycin Brand Names (International):
- Apokalin
- Bykomycin
- Concatag
- Cysto-Myacyne N
- Endomixin
- Enteromicina
- Fradyl
- Glubacida
- Minims Neomycin
- Myacyne
- Nebacetin N Spruhverband
- Nebapol B
- Neo-Mix
- Neomas
- Neomicina
- Neomycin
- Neomycin Drossapharm
- Neomycine
- Neomycine Diamant
- Neomycine Minims
- Neomycinsulfat Chevita
- Neomycinum
- Nivemycin
- Ofodex
- Rovicine
- Sulfate de Neomycine-Chauvin
- Trioftín
- Unguentum Neomycini
- Uro-Beniktol N
- Uro-Nebacetin N
- Vagicillin
- Vinacil
- Vitacilina
- Xyloderm
Neomycin Brand Names in Pakistan:
Neomycin Ointment 5 Mg |
|
Ismycin Skin | Isis Pharmaceutical |
Nemozin | Zanctok Pharmaceuticals |
Neomycin Ointment 0.5 % W/W |
|
Biozon | Biogen Pharma |
Elimycin | Elite Pharma |
Neocin | Semos Pharmaceuticals (Pvt) Ltd. |
NeomycinOintment | Krka-Pak Pharmaceutical & Chemical Works |
NeomycinOintment | Geofman Pharmaceuticals |
NeomycinOirntment | Eros Pharmaceuticals |
NeomycinOintment | Amros Pharmaceuticals. |
NeomycinOintment | Swiss Pharmaceuticals (Pvt) Ltd. |
Neopharm | Epharm Laboratories |
Neosul | Epoch Pharmaceutical |
Newcin | Euro Pharma International |
Tasomycin | Tas Pharmaceutical |
Webnate -N | Webros Pharmaceuticals |
Neomycin Cream 0.5 % W/W |
|
Beone Plus | Reliance Pharma |
Neogray | Gray`S Pharmaceuticals |
Neoskin | Trigon Pharmaceuticals Pakistan (Pvt) Ltd. |
Webnate -N , | Webros Pharmaceuticals |
Neomycin Tablets 500 Mg |
|
Lavenda | Hamaz Pharmaceutical (Pvt) Ltd. |