Neomycin


Concise Prescribing Info
Indications/Uses
Listed in Dosage.
Dosage/Direction for Use
Adult : PO Pre-op intestinal antisepsis 1 g hrly for 4 hr then 4 hrly for 2-3 days before surgery. Hepatic encephalopathy As an adjunct: 4-12 g/day in divided doses for 5-7 days. Chronic hepatic insufficiency: 4 g/day over an indefinite period. Topical/Cutaneous Skin infections As cream/oint: Clean the affected area and apply bid.
Dosage Details
Oral
Hepatic encephalopathy
Adult: As an adjunctive therapy: 4-12 g daily in divided doses for 5-7 days. For chronic hepatic insufficiency, 4 g daily over an indefinite period.
Child: As an adjunctive therapy: 50-100 mg/kg daily in divided doses for 5-7 days.

Oral
Preoperative intestinal antisepsis
Adult: 1 g hrly for 4 hr then 4 hrly for 2-3 days before surgery.
Child: 6-12 yr 250-500 mg 4 hrly for 2-3 days before surgery; >12 yr 1 g 4 hrly for 2-3 days before surgery.

Topical/Cutaneous
Skin infections
Adult: As cream/oint: Clean the affected area and apply bid.
Child: >2 yr Same as adult dose.
Renal Impairment
Oral:
Dosage adjustment needed.
Administration
May be taken with or without food.
Contraindications
Hypersensitivity to neomycin and other aminoglycosides. Intestinal obstruction. Infants <1 yr.
Special Precautions
Patient w/ neuromuscular disorders (e.g. myasthenia gravis), pre-existing vertigo, tinnitus or hearing loss. Prolonged use may result in overgrowth of non-susceptible organisms. Renal and hepatic impairment. Childn. Pregnancy and lactation.
Adverse Reactions
Ototoxicity; nausea, vomiting, diarrhoea, increased salivation, stomatitis, increased hepatic enzymes and bilirubin levels, blood dyscrasias, haemolytic anaemia, confusion, paraesthesia, disorientation, nystagmus, hypersensitivity reactions (e.g. dermatitis, pruritus, drug fever); malabsorption syndrome w/ steatorrhoea and diarrhoea, electrolyte disturbances (e.g. hypomagnesaemia, hypocalcaemia, hypokalaemia).
Potentially Fatal: Nephrotoxicity; resp depression and arrest following neuromuscular blockade; anaphylaxis.
MonitoringParameters
Monitor auditory, vestibular and renal function.
Overdosage
Symptoms: Exacerbation of adverse events (e.g. nausea, diarrhoea, nephrotoxicity, ototoxicity). Management: Prolonged assisted ventilation. Haemodialysis is indicated if renal and auditory impairment occur.
Drug Interactions
Additive nephrotoxic and neurotoxic effect w/ other aminoglycosides (e.g. paromomycin), bacitracin, cisplatin, vancomycin, amphotericin B, polymyxin B, colistin and viomycin. Enhanced toxicity w/ potent diuretics (e.g. ethacrynic acid, furosemide). May impair the absorption of other drugs (e.g. phenoxymethylpenicillin, digoxin, methotrexate and some vit). May reduce the efficacy of OCs. May enhance the effect of acarbose. May enhance the effect of non-depolarising muscle relaxants. May antagonise the parasympathomimetic effect of neostigmine and pyridostigmine. May increase the risk of hypocalcaemia in patients receiving bisphosphonates. May alter INR when given w/ anticoagulants. May inactivate oral typhoid vaccine.
Action
Description: Neomycin interferes w/ bacterial protein synthesis by binding to 30S ribosomal subunits.
Pharmacokinetics:
Absorption: Poorly absorbed from the GI tract. Time to peak plasma concentration: 1-4 hr (oral).
Distribution: Low concentrations in intestinal wall and muscles. Volume of distribution: 0.36 L/kg. Plasma protein binding: ≤30%.
Metabolism: Undergoes minimal hepatic metabolism.
Excretion: Via faeces (approx 97% of an oral dose, as unchanged drug); via urine (30-50% of absorbed drug, unchanged). Plasma half-life: 2-3 hr.
Chemical Structure

Chemical Structure Image
Neomycin

Source: National Center for Biotechnology Information. PubChem Database. Neomycin, CID=8378, https://pubchem.ncbi.nlm.nih.gov/compound/Neomycin (accessed on Jan. 21, 2020)

Storage
Store between 20-25°C.
References
Anon. Neomycin. Lexicomp Online. Hudson, Ohio. Wolters Kluwer Clinical Drug Information, Inc. https://online.lexi.com. Accessed 24/10/2014.

Baclezene Cream (Curazene, LLC). DailyMed. Source: U.S. National Library of Medicine. https://dailymed.nlm.nih.gov/dailymed/. Accessed 24/10/2014.

Buckingham R (ed). Neomycin. Martindale: The Complete Drug Reference [online]. London. Pharmaceutical Press. https://www.medicinescomplete.com. Accessed 24/10/2014.

McEvoy GK, Snow EK, Miller J et al (eds). Neomycin Sulfate (Topical). AHFS Drug Information (AHFS DI) [online]. American Society of Health-System Pharmacists (ASHP). https://www.medicinescomplete.com. Accessed 24/10/2014.

McEvoy GK, Snow EK, Miller J et al (eds). Neomycin Sulfate. AHFS Drug Information (AHFS DI) [online]. American Society of Health-System Pharmacists (ASHP). https://www.medicinescomplete.com. Accessed 24/10/2014.

Disclaimer: This information is independently developed by MIMS based on Neomycin from various references and is provided for your reference only. Therapeutic uses, prescribing information and product availability may vary between countries. Please refer to MIMS Product Monographs for specific and locally approved prescribing information. Although great effort has been made to ensure content accuracy, MIMS shall not be held responsible or liable for any claims or damages arising from the use or misuse of the information contained herein, its contents or omissions, or otherwise. Copyright © 2020 MIMS. All rights reserved. Powered by MIMS.com
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