Neomycin (Dosing, Interaction, Side Effect, Administration, Etc..)

DRUG CLASS:
Aminoglycoside
Antibacterial
Antibiotic

DOSING:

Adult Dose

:
Hepatic encephalopathy:
4 to 12 g/day ORALLY in divided doses for 5 to 6 days; maximum 12 g/day; do not

use

longer than 2 weeks

Infection of skin; In minor cuts; scrapes; and burns; Prophylaxis:
Apply small amount TOPICALLY to affected area not more than 2 to 3 times daily; may be covered with a sterile bandage

Preparation of bowel for procedure; Preoperative; Adjunct:
1 g ORALLY 19; 18; and 9 hours prior to surgery in combination with recommended bowel preparation regimen which includes erythromycin

Pediatric Dose

:
Infection of skin; in minor cuts; scrapes; and burns; Prophylaxis:
Apply small amount TOPICALLY to affected area not more than 2 to 3 times daily; may be covered with a sterile bandage

INDICATIONS:
FDA-LABELED INDICATIONS:
Hepatic encephalopathy
Infection of skin; in minor cuts; scrapes; and burns; Prophylaxis
Preparation of bowel for procedure; Preoperative; Adjunct

NON-FDA LABELED INDICATIONS:
Eczema
Skin grafting

MECHANISM OF ACTION:

Neomycin sulfate

is an aminoglycoside antibiotic that exerts its bactericidal effect by inhibiting protein synthesis in susceptible bacterial cells. It is effective against gram-negative bacilli and some strains of gram-positive microorganisms; but ineffective against anaerobic bowel flora.

ADVERSE EFFECT:
Common:
Gastrointestinal:
Diarrhea
Nausea
Vomiting

Serious:
Otic:
Ototoxicity

Renal:
Nephrotoxicity

Respiratory:
Respiratory tract paralysis

CONTRAINDICATION:
Hypersensitivity to neomycin/aminoglycosides
Inflammatory/ulcerative gastrointestinal disease
Intestinal obstruction

DRUG INTERATION:
Caution should be taken in concurrent or serial

use of other neurotoxic

and/or nephrotoxic drugs because of possible enhancement of the nephrotoxicity and/or ototoxicity of

neomycin

Caution should also be taken in concurrent or serial

use of other aminoglycosides

and polymyxins because they may enhance neomycin's nephrotoxicity and/or ototoxicity and

potentiate neomycin

's neuromuscular blocking effects.

Oral neomycin

inhibits the gastrointestinal absorption of penicillin V, oral vitamin B-12, methotrexate and 5-fluorourcil. The gastrointestinal absorption of digoxin also appears to be inhibited. Therefore, digoxin serum levels should be monitored.
Oral neomycin may enhance the effect of coumarin in anticoagulants by decreasing vitamin K availability.

Major:
Alcuronium (probable)
Atracurium (probable)
Cidofovir (theoretical)
Cisatracurium (probable)
Colistimethate Sodium (theoretical)
Decamethonium (probable)
Doxacurium (probable)
Ethacrynic Acid (theoretical)
Fazadinium (probable)
Foscarnet (theoretical)
Furosemide (theoretical)
Gallamine (probable)
Hexafluorenium (probable)
Metocurine (probable)
Mivacurium (probable)
Pancuronium (probable)
Pipecuronium (probable)
Rapacuronium (probable)
Rocuronium (probable)
Sorafenib (theoretical)
Tubocurarine (probable)
Vecuronium (probable)

Moderate:
Bumetanide(Probable)
Digoxin (Probable)

PHAMACOKINETICS:
Absorption:
Poor absorbed

Distribution:
Plasma Protein binding: 0% to 30%

Excretion:
Fecal: approximately 97% (unabsorbed drug) as unchanged
Renal: small fraction; primary site
Dialyzable: yes (hemodialysis)

PRECAUSION:
Pre-existing renal; vestibular; or auditory impairment
Concomitant anesthesia or neuromuscular blockers; risk for neuromuscular blockade; respiratory paralysis
Concomitant neurotoxic; ototoxic; or nephrotoxic drugs; age (very young/very old) and dehydration; risk factors for toxicity

PREGNENCY CATEGORY:
D (FDA)
D (AUS)

BREAST FEEDING:
Infant Risk cannot be ruled out

MONITORING:
Improvement in neurologic function may indicate efficacy
Reduction in serum ammonia levels may indicate efficacy
Renal function; especially in high-risk patients; at baseline and periodically
Urinalysis for proteinuria; decreased specific gravity and casts and cells in urine; at baseline and periodically
Perform urinalysis to identify increased excretion of protein; specific gravity; casts and cells; at baseline and periodically during therapy

Neomycin serum concentrations

to avoid toxic levels
Serial vestibular and audiometric tests; especially in high-risk patients; even after drug withdrawal
Signs and symptoms of neurotoxicity; even after drug withdrawal
Vestibulocochlear nerve (8th cranial nerve) function; at baseline and periodically

DOSAGE FORM:
Oral Tablet:
500mg

Oral solution:
125mg/5ml

TREATMENTS:
MANAGEMENT OF TOXICITY:
Treatment is symptomatic and supportive. Maintain good urine output (3 to 6 mL/kg/hr) with IV fluids. For mild allergic reactions; treat with antihistamines; if severe; airway management; epinephrine; ECG monitoring; IV fluids.

TOXICOLOGY:
Nephrotoxicity may occur from gentamicin with persistent peak serum concentrations of more than 12 mcg/mL or trough concentrations more than 2 mcg/mL. Nephrotoxicity may occur from amikacin peak concentrations persistently greater than 20 to 35 mcg/mL and trough concentrations greater than 8 mcg/mL. The amount of aminoglycoside present in ophthalmic drops or ointments; otic preparations; or topical formulations do not cause systemic toxicity after ingestion.

PATIENT COUNSELING OR CLINICAL TEACHING:
This drug may cause diarrhea; nausea; and vomiting
Instruct patients receiving oral preparations to report signs/symptoms of neurotoxicity; ototoxicity; or nephrotoxicity
Patients receiving oral preparations should report signs/symptoms of respiratory tract paralysis. Patients who have recently received anesthesia are at a higher risk for this adverse effect
Tell patient to maintain adequate hydration to decrease the risk of toxicity
Advise patient there are multiple significant drug-drug interactions for this drug. Consult healthcare professional prior to new drug use (including over-the-counter and herbal drugs)