Neomycin is a non-absorbable antibiotic of the aminoglycoside group. It is mostly used as a topical preparation, however, it is also used orally for bacterial overgrowth and bacterial eradication.

Indications of Neomycin:

• Hepatic coma (portal-systemic encephalopathy):

  • It is used as a combination therapy in hepatic coma.

• Perioperative prophylaxis:

  • It is given as combination therapy with enteric-coated erythromycin for the suppression of the normal bacterial bowel flora.

Neomycin dose in adults:

Neomycin dose in the perioperative prophylaxis:

• 1g per oral at 1 PM, 2 PM, and 11 PM on the day preceding 8 AM surgery in addition to oral erythromycin for cleansing (manufacturer’s labeling) or in alternatively in combination with erythromycin/metronidazole and intravenous antibiotics on the day of surgery.

Neomycin dose in the treatment of Hepatic encephalopathy:

• 4 to 12 g per oral daily divided every 4 to 6 hours for 5 to 6 days

Neomycin dose in the treatment of Chronic hepatic insufficiency:

• 4 g  per oral daily for an indefinite period

Neomycin dose in children:

Note: Dosage is expressed in terms of neomycin sulfate.

Neomycin dose for the prophylactic treatment of recurrent cholangitis after Kasai porto-enterostomy:

• 25 to 50 mg/kg per oral per day in 4 divided doses 4 days per week continued until 2 to 3 years of age.

Treatment dose in the Enteric bacteria eradication (including gut flora)/ infection:

• 50 to 100 mg/kg per oral per day divided every 6 to 8 hours
• The maximum daily dose: 12 g/day
• Treatment duration should not be more than 2 weeks due to systemic toxicity.

Neomycin dose for the treatment of Hepatic encephalopathy:

• 50 to 100 mg/kg per oral per day divided every 6 hours for one week with or without lactulose
• The maximum daily dose: 12 g/day

Treatment dose in the Preoperative intestinal antisepsis: 

• 15 mg/kg per oral for 3 doses administered over 10 hours (eg, at 1 PM, 2 PM, and 11 PM) prior to surgery used concurrently with erythromycin or metronidazole with or without mechanical intestinal cleansing.
• The maximum dose is 1,000 mg/dose

Pregnancy Risk Factor D

• It can cross placenta.
• Use of aminoglycosides during pregnancy can lead to irreversible bilateral congenital hearing loss in children.
• Higher doses of oral therapy may result in malabsorption of nutrients.

Neomycin use during breastfeeding:

• It is not known if the drug was absorbed into breast milk.
• Manufacturer recommends that you stop feeding/ Drug therapy is stopped depending on how important it is for the mother.
• The infant's bowel flora may be altered by antibiotic exposure.

Dose adjustment in renal disease:

• There are no dosage adjustments provided in manufacturer’s labeling.
• The risk of nephrotoxicity or ototoxicity is increased in patients with renal impairment, therefore, dose reduction or discontinuation is necessary.

Dose adjustment in liver disease:

There are no dosage adjustments provided in manufacturer’s labeling.

Side Effects of Neomycin:

• Central nervous system:

  • Sore mouth

• Gastrointestinal:

  • Anorectal Pain
  • Diarrhea
  • Mouth Irritation
  • Nausea
  • Rectal Irritation
  • Vomiting

Contraindication to Neomycin:

They include hypersensitivity to the Neomycin or any component in the formulation Inflammatory bowel disease Intestinal obstruction

Warnings and precautions

• Malabsorption

  • In larger amounts, malabsorption of fats, Sodium and Iron, Vitamin B12, Vitamin B12, Vitamin B12, Vitamin B12, Nitrogen, Cholesterol, Carotene, Vitamin B12 and glucose can occur.

• Nephrotoxicity: [US Boxed Warning]

  • Dehydration, pre-existing kidney impairment, and a combination nephrotoxic medication are all risk factors for renal toxicities.

• The US Boxed Warning: Neuromuscular Blockade and Respiratory Paralysis

  • Dosing immediately after anesthesia or using other muscle relaxants could cause neuromuscular blockade or respiratory paralysis.

• Neurotoxicity: [US Boxed Warn]

  • You may experience symptoms such as numbness or skin tingling, muscle spasms, seizures, or other signs.

• Superinfection

  • Fungal or bacterial superinfection(C. difficile-associated diarrhea/pseudomembranous colitis) can be seen with long term therapy.

• Hearing impairment:

  • Patients with hearing loss, vertigo, or tinnitus should be cautious.

• Neuromuscular disorders:

  • Patients with neuromuscular disorders like myasthenia gravis or Parkinson's disease should be cautious.

• Renal impairment

  • Patients with pre-existing renal impairment need to be reduced in dosage

Neomycin: Drug Interaction

Monitoring parameters:

Monitoring is required for :

• Renal function tests (BUN and Creatinine)
• audiometry in symptomatic patients

How to administer Neomycin?

It should be given orally irrespective of food, Administration at prescribed dosing times is necessary in preoperative intestinal antisepsis.

Mechanism of action of Neomycin:

It acts by binding with 30S ribosomal Subunits, causing an interruption in bacterial protein synthesis

Absorptionis not recommended for subQ or oral administration.

Distribution97% of the orally administered dose is still in the gastrointestinal tract. Neomycin is absorbed into tissues and concentrated in the renal cortex. The inner ear can also accumulate if you take repeated doses.

Protein binding0% to 30%

Time required to reach peak serum concentration: 1 to 4 Hours

Excretion: Feces (97% oral dose as unchanged drugs); urine (30% to 50%) of absorbed drug is unchanged drugs

Neomycin Brand Names (International):

• Apokalin
• Bykomycin
• Concatag
• Cysto-Myacyne N
• Endomixin
• Enteromicina
• Fradyl
• Glubacida
• Minims Neomycin
• Myacyne
• Nebacetin N Spruhverband
• Nebapol B
• Neo-Mix
• Neomas
• Neomicina
• Neomycin
• Neomycin Drossapharm
• Neomycine
• Neomycine Diamant
• Neomycine Minims
• Neomycinsulfat Chevita
• Neomycinum
• Nivemycin
• Ofodex
• Rovicine
• Sulfate de Neomycine-Chauvin
• Trioftín
• Unguentum Neomycini
• Uro-Beniktol N
• Uro-Nebacetin N
• Vagicillin
• Vinacil
• Vitacilina
• Xyloderm

Neomycin Brand Names in Pakistan: