Neomycin + Polymyxin B + Gramicidin


Concise Prescribing Info
Indications/Uses
Superficial ocular infections.
Dosage/Direction for Use
Adult : Ophthalmic Each solution contains neomycin 1.75 mg/mL, polymyxin B 10,000 units/mL and gramicidin 0.025 mg/mL: Instill 1-2 drops into affected eye(s) 4 hourly for 7-10 days. For severe cases: 2 drops hourly.
Dosage Details
Ophthalmic
Superficial ocular infections
Adult: Available preparation:
Neomycin 1.75 mg/mL, polymyxin B 10,000 units/mL and gramicidin 0.025 mg/mL

Instill 1-2 drops into affected eye(s) 4 hourly for 7-10 days. For severe cases: 2 drops hourly.
Incompatibility
Polymyxin B: Inactivated by strong acids and alkalis.
Contraindications
Hypersensitivity to neomycin, polymyxin B or gramicidin, or to any of its component.
Special Precautions
Patient with otitis media. Prolonged use may cause overgrowth of nonsusceptible organisms, including fungi. Pregnancy and lactation.
Adverse Reactions
Significant: Hypersensitivity reaction (e.g. angioedema, swelling, conjunctival erythema), local sensitisation (e.g. reddening, pruritus, oedema), superinfection (prolonged use).
Eye disorders: Local irritation, stinging or burning sensation, inflammation.
Skin and subcutaneous tissue disorders: Rash, urticaria, vesicular eruption.
Patient Counseling Information
Remove contact lenses prior to ophthalmic administration and reinsert after 15 minutes.
MonitoringParameters
Monitor for signs and symptoms of hypersensitivity.
Drug Interactions
Neomycin and Polymyxin B: Increased risk of respiratory depression and apnoea with neuromuscular blocking agents.
Action
Description: Neomycin, an aminoglycoside antibacterial, is bactericidal against a variety of gram-positive and gram-negative organisms. It inhibits bacterial protein synthesis by irreversibly binding to the cell’s 30S ribosomal ribonucleic acid subunits.
Polymyxin B, a lipopeptide antibacterial, is effective against a variety of gram-negative organisms. It damages the bacterial cell membrane by binding to the membrane’s phospholipids that causes leakage of intracellular contents.
Gramicidin, a polypeptide antibacterial, is effective against a variety of gram-positive organisms. It damages the bacterial cell membrane by forming channels through the membrane that increases its permeability to inorganic cations.
Pharmacokinetics:
Distribution: Polymyxin B: Widely distributed and extensively bound to cell membranes in the tissues.
Excretion: Neomycin: Via urine. Elimination half-life: 2-3 hours.
Polymyxin B: Via urine (Approx 60% as unchanged drug). Elimination half-life: Approx 6 hours.
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)


Chemical Structure Image
Polymyxin B

Source: National Center for Biotechnology Information. PubChem Database. Polymyxin b, CID=49800004, https://pubchem.ncbi.nlm.nih.gov/compound/Polymyxin-b (accessed on Jan. 21, 2020)

Storage
Store between 15-25°C. Protect from light.
References
Anon. Neomycin Sulfate (EENT). AHFS Clinical Drug Information [online]. Bethesda, MD. American Society of Health-System Pharmacists, Inc. https://www.ahfscdi.com. Accessed 13/04/2018.

Anon. Neomycin, Polymyxin B, and Gramicidin. Lexicomp Online. Hudson, Ohio. Wolters Kluwer Clinical Drug Information, Inc. https://online.lexi.com. Accessed 06/04/2018.

Anon. Polymyxin B (EENT). AHFS Clinical Drug Information [online]. Bethesda, MD. American Society of Health-System Pharmacists, Inc. https://www.ahfscdi.com. Accessed 13/04/2018.

Buckingham R (ed). Gramicidin. Martindale: The Complete Drug Reference [online]. London. Pharmaceutical Press. https://www.medicinescomplete.com. Accessed 06/04/2018.

Buckingham R (ed). Neomycin. Martindale: The Complete Drug Reference [online]. London. Pharmaceutical Press. https://www.medicinescomplete.com. Accessed 06/04/2018.

Buckingham R (ed). Polymyxin B Sulfate. Martindale: The Complete Drug Reference [online]. London. Pharmaceutical Press. https://www.medicinescomplete.com. Accessed 06/04/2018.

Neomycin and Polymyxin B Sulfates and Gramicidin Solution/Drops (A-S Medication Solutions). DailyMed. Source: U.S. National Library of Medicine. https://dailymed.nlm.nih.gov/dailymed/. Accessed 06/04/2018.

Disclaimer: This information is independently developed by MIMS based on Neomycin + Polymyxin B + Gramicidin 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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