Classes
DEA Class; Rx
Common Brand Names; Neo-Fradin, Myciguent, Mycifradin
- Aminoglycosides
Description
Aminoglycoside antibiotic derived from Streptomyces fradiae. Most often used topically as an antiinfective. Oral bioavailability is poor, but is administered orally in patients with hepatic coma or portal-systemic encephalopathy. Oral neomycin also has a lipid-lowering effect but is infrequently used for this purpose. Administration as a surgical irrigant is no longer recommended. Not indicated for the treatment of systemic infections because it can cause irreversible ototoxicity.
Indications
Indicated for Pre-Op Intestinal Antisepsis
Indicated for Hepatic Encephalopathy, Diarrhea Caused by Enteropathogenic E.coli
Other Indications & Uses
- Off-label: reduce LDL
Contraindications
Hypersensitivity
Patients with a history of hypersensitivity or serious toxic reactions to other aminoglycosides
Patients with inflammatory or ulcerative gastrointestinal disease
Adverse Effects
- Diarrhea
- Nausea/vomiting
- Irritation or soreness of mouth or rectal area
- Contact dermatitis (topical)
- Dyspnea
- Eosinophilia
- Nephrotoxicity
- Neurotoxicity
- Ototoxicity (auditory, vestibular)
Warnings
Potential for enhanced gastrointestinal absorption of neomycin in patients with inflammatory or ulcerative gastrointestinal disease; use is contraindicated
Rsk of hearing loss continues after drug withdrawal
Aminoglycoside antibiotics cross placenta; there have been several reports of total irreversible bilateral congenital deafness in children whose mothers received streptomycin during pregnancy
Prescribing this antibiotic in the absence of a proven or strongly suspected bacterial infection or a prophylactic indication is unlikely to provide benefit to patient and increases risk of development of drug-resistant bacteria
Use of this drug may result in overgrowth of non-susceptible organisms, particularly fungi; if this occurs, appropriate therapy should be instituted
Neomycin is quickly and almost totally absorbed from body surfaces (except the urinary bladder) after local irrigation and when applied topically in association with surgical procedures
Delayed-onset, irreversible deafness, renal failure, and death due to neuromuscular blockade (regardless of status of renal function) reported following irrigation of both small and large surgical fields with minute quantities of neomycin
Cross-allergenicity among aminoglycosides has been demonstrated; aminoglycosides should be used with caution in patients with muscular disorders such as myasthenia gravis or parkinsonism since these drugs may aggravate muscle weakness because of their potential curare-like effect on neuromuscular junction
Small amounts of orally administered neomycin are absorbed through intact intestinal mucosa; there have been many reports in the literature of nephrotoxicity and/or ototoxicity with oral use of neomycin
If renal insufficiency develops during oral therapy, consider reducing the drug dosage or discontinuing therapy
An oral neomycin dose of 12 g/day produces malabsorption syndrome for various substances including fat, nitrogen, cholesterol, carotene, glucose, xylose, lactose, sodium, calcium, cyanocobalamin, and iron.
Orally administered neomycin increases fecal bile acid excretion and reduces intestinal lactase activity
Pregnancy and Lactation
Although serious side effects to fetus or newborn have not been reported in treatment of pregnant women with other aminoglycosides, potential for harm exists
Not known whether neomycin is excreted in human milk but shown to be excreted in cow milk following a single intramuscular injection; other aminoglycosides have been shown to be excreted in human milk
Maximum Dosage
12 g/day PO; specific maximum dosage information is not available for topical preparations.
12 g/day PO; specific maximum dosage information is not available for topical preparations.
Safety and efficacy have not been established.
Safety and efficacy have not been established.
How supplied
Neomycin