Neomycin and polymyxin B (Maxitrol) is a combination of non-absorbable antibiotics that are used for bladder irrigation in patients who develop bacteriuria due to prolonged bladder catheterization.

Neomycin and polymyxin B (Maxitrol) Uses:

• Urinary bladder irrigant:

  • It is used as a bladder irrigant (for short-term use of up to 10 days) in patients who have bacteriuria due to the use of long-term indwelling catheters to prevent bacteria and septicemia.

Neomycin and polymyxin B (Maxitrol) Dose in Adults

Neomycin and polymyxin B Dose in the treatment of Urinary bladder irrigant:

• Intravesical:
  • Add 1 mL irrigant to 1,000 ml isotonic saline solution per day as continuous irrigation for up to 10 days.

Neomycin and polymyxin B (Maxitrol) Dose in Childrens

Neomycin and polymyxin B Dose in the treatment of Urinary bladder irrigant:

Note: The data is limited and the effectiveness of the drug varies. Most of the experience with the drug has been in patients with spinal cord injury or neurogenic bladder.

• Children and Adolescents:

  • Irrigant solution (neomycin 40 mg/polymyxin B 200,000 units/L):
    • Intravesical: 10 mL instilled at the end of each catheterization and retained until next catheterization.
    • In older adolescents, 30 mL 2 to 3 times daily has been used for asymptomatic bacteriuria.
  • Note: Use has generally been replaced with other agents (eg, saline, gentamicin).

Pregnancy Category: C

• Animal reproduction studies have not been conducted with this combination
• There are reports of total irreversible bilateral congenital deafness in children whose mothers received streptomycin during pregnancy.
• Talk to individual agents.

Use during breastfeeding:

• It is unknown if the drug will be excreted into breastmilk.

Dose in Kidney Disease:

The manufacturer has not recommended any adjustments in the dose in patients with kidney disease.

Dose in Liver disease:

The manufacturer has not recommended any adjustments in the dose in liver disease.

Side effects of Neomycin and polymyxin B (Maxitrol):

• Central Nervous System:

  • Localized Burning

• Dermatologic:

  • Contact Dermatitis
  • Erythema
  • Skin Rash
  • Urticaria

• Genitourinary:

  • Bladder Mucosa Irritation
  • Nephrotoxicity

• Neuromuscular & Skeletal:

  • Neuromuscular Blockade

• Otic:

  • Ototoxicity

Contraindications to Neomycin and polymyxin B (Maxitrol):

• Allergy reactions to neomycin, neomycin B or any other component of the formulation
• Patients who have had severe allergic reactions to aminoglycosides in the past.

Warnings and precautions

• Superinfection

  • Long-term use of the drug can lead to fungal and bacterial superinfections, such as C. difficile-associated diarrhea or pseudomembranous collitis.
  • CDAD can occur even after two months of last antibiotic use.

• Systemic toxicities:

  • Systemic absorption may lead to nephrotoxicity, ototoxicity, or neuromuscular blockade.
  • Systemic absorption can be more common in patients who have bladder defects or who have had surgery that has caused injury to the bladder wall.

• Renal impairment

  • It can increase the risk of kidney toxicity. You should use it with caution.

Neomycin and polymyxin B: Drug Interaction

Monitoring parameters:

• Urinalysis,
• renal function.

How to administer Neomycin and polymyxin B?

• It is indicated only for the irrigation of the bladder and not for parenteral administration.
• The inflow lumen of the 3-way catheter should be connected to the irrigation container to allow the continuous irrigation of the urinary bladder.
• The bladder rinse should be continuous and the irrigation should not be interrupted for more than a few minutes.
• The flow rate of the irrigation should be adjusted to 1 liter per 24 hours.
• However, if the patients' urine output exceeds 2 liters per 24 hours, the flow rate should be set at a rate of 2 liters per 24 hours.

Mechanism of action of Neomycin and polymyxin B:

Neomycin:

• It binds with the 30S subunit of the ribosomal ribosomal subunit, inhibits bacterial protein synthesis, and indirectly inhibits bacterial replication.

Polymyxin B

• By binding to phospholipids, it damages the bacterial cell membrane. It causes a decrease in bacterial cellular permeability, which allows for the leakage intracellular content.

Talk to individual agents.

Absorption:

• It is only minimally absorbed when used topically. Systemic absorption can occur if the bladder is inflamed or denuded.

International Brands of Neomycin and polymyxin B:

• Neosporin G.U. Irrigant
• Neosporin Irrigating Solution
• Alosol
• Isopto Statrol
• Maxitrol
• Statrol

Neomycin and polymyxin B Brands Names in Pakistan:

• Maxitrol