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Neomycin

    DEA Class; Rx

    Common Brand Names; Neo-Fradin, Myciguent, Mycifradin

    • Aminoglycosides
     

    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.

    Indicated for Pre-Op Intestinal Antisepsis

    Indicated for Hepatic Encephalopathy, Diarrhea Caused by Enteropathogenic E.coli

    Other Indications & Uses

    • Off-label: reduce LDL

    Hypersensitivity

    Patients with a history of hypersensitivity or serious toxic reactions to other aminoglycosides

    Patients with inflammatory or ulcerative gastrointestinal disease

    • Diarrhea
    • Nausea/vomiting
    • Irritation or soreness of mouth or rectal area
    • Contact dermatitis (topical)
    • Dyspnea
    • Eosinophilia
    • Nephrotoxicity
    • Neurotoxicity
    • Ototoxicity (auditory, vestibular)

    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

    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

    Adults

    12 g/day PO; specific maximum dosage information is not available for topical preparations.

    Elderly

    12 g/day PO; specific maximum dosage information is not available for topical preparations.

    Adolescents

    Safety and efficacy have not been established.

    Children

    Safety and efficacy have not been established.

    Neomycin

    tablet

    • 500mg

    oral solution

    • 25mg/mL