General Articles

Bacitracin, neomycin, and polymyxin B

U.S. BRAND NAMES — Neosporin® Neo To Go® [OTC]; Neosporin® Topical [OTC]

PHARMACOLOGIC CATEGORY
Antibiotic, Ophthalmic
Antibiotic, Topical

DOSING: ADULTS
Ophthalmic infection: Ophthalmic ointment: Instill 1/2″ into the conjunctival sac every 3-4 hours for 7-10 days for acute infections

Superficial dermal infection: Topical: Apply 1-3 times/day to infected area; may cover with sterile bandage if necessary.

DOSING: PEDIATRIC — Refer to adult dosing.

(For additional information see “Bacitracin, neomycin, and polymyxin B: Pediatric drug information”)

DOSING: ELDERLY — Refer to adult dosing.

DOSAGE FORMS — Excipient information presented when available (limited, particularly for generics); consult specific product labeling.

Ointment, ophthalmic: Bacitracin 400 units, neomycin 3.5 mg, and polymyxin B 10,000 units per g (3.5 g)

Ointment, topical: Bacitracin 400 units, neomycin 3.5 mg, and polymyxin B 5000 units per g (0.9 g, 15 g, 30 g, 454 g)
Neosporin®: Bacitracin 400 units, neomycin 3.5 mg, and polymyxin B 5000 units per g (15 g, 30 g)
Neosporin® Neo To Go®: Bacitracin 400 units, neomycin 3.5 mg, and polymyxin B 5000 units per g (0.9 g)

DOSAGE FORMS: CONCISE
Ointment, ophthalmic: Bacitracin 400 units, neomycin 3.5 mg, and polymyxin B 10,000 units per g (3.5 g)

Ointment, topical: Bacitracin 400 units, neomycin 3.5 mg, and polymyxin B 5000 units per g (0.9 g, 15 g, 30 g, 454 g)
Neosporin® [OTC]: Bacitracin 400 units, neomycin 3.5 mg, and polymyxin B 5000 units per g (15 g, 30 g)
Neosporin® Neo To Go® [OTC]: Bacitracin 400 units, neomycin 3.5 mg, and polymyxin B 5000 units per g (0.9 g)

SEE MORE:  Acetaminophen, isometheptene, and dichloralphenazone

GENERIC EQUIVALENT AVAILABLE — Yes

USE — Helps prevent infection in minor cuts, scrapes, and burns; short-term treatment of superficial external ocular infections caused by susceptible organisms

ADVERSE REACTIONS SIGNIFICANT — Frequency not defined.

Dermatologic: Reddening, allergic contact dermatitis

Local: Itching, failure to heal, swelling, irritation

Ophthalmic: Conjunctival edema

Miscellaneous: Anaphylaxis

CONTRAINDICATIONS — Hypersensitivity to neomycin, polymyxin B, zinc bacitracin, or any component of the formulation; epithelial herpes simplex keratitis; mycobacterial or fungal infections; topical ointments for external use only

WARNINGS / PRECAUTIONS
Dosage form specific issues: Ophthalmic ointment: Bacterial keratitis has been reported with the use of topical ophthalmic products in multiple-dose containers. Care should be taken to not contaminate the container. Topical ointment: When used for self-medication (OTC use), patients should notify healthcare provider if needed for >1 week. Should not be used for self-medication on deep or puncture wounds, animal bites, or serious burns. Not for application to large areas of the body.

DRUG INTERACTIONS
Amphotericin B: May enhance the nephrotoxic effect of Aminoglycosides. Risk C: Monitor therapy

Bisphosphonate Derivatives: Aminoglycosides may enhance the hypocalcemic effect of Bisphosphonate Derivatives. Risk C: Monitor therapy

Capreomycin: May enhance the neuromuscular-blocking effect of Polymyxin B. Risk C: Monitor therapy

Capreomycin: May enhance the neuromuscular-blocking effect of Aminoglycosides. Risk C: Monitor therapy

SEE MORE:  DELCEF Delta Pharma

CARBOplatin: Aminoglycosides may enhance the ototoxic effect of CARBOplatin. Especially with higher doses of carboplatin. Risk C: Monitor therapy

Cardiac Glycosides: Aminoglycosides may decrease the absorption of Cardiac Glycosides. Risk C: Monitor therapy

CISplatin: May enhance the nephrotoxic effect of Aminoglycosides. Risk C: Monitor therapy

Colistimethate: Aminoglycosides may enhance the nephrotoxic effect of Colistimethate. Aminoglycosides may enhance the neuromuscular-blocking effect of Colistimethate. Risk D: Consider therapy modification

Colistimethate: Polymyxin B may enhance the neuromuscular-blocking effect of Colistimethate. Risk C: Monitor therapy

CycloSPORINE: Aminoglycosides may enhance the nephrotoxic effect of CycloSPORINE. Risk C: Monitor therapy

Gallium Nitrate: Aminoglycosides may enhance the nephrotoxic effect of Gallium Nitrate. Risk X: Avoid combination

Loop Diuretics: May enhance the adverse/toxic effect of Aminoglycosides. Specifically, nephrotoxicity and ototoxicity. Risk C: Monitor therapy

Neuromuscular-Blocking Agents: Polymyxin B may enhance the neuromuscular-blocking effect of Neuromuscular-Blocking Agents. Risk D: Consider therapy modification

Neuromuscular-Blocking Agents: Aminoglycosides may enhance the respiratory depressant effect of Neuromuscular-Blocking Agents. Risk C: Monitor therapy

Nonsteroidal Anti-Inflammatory Agents: May decrease the excretion of Aminoglycosides. Data only in premature infants. Risk C: Monitor therapy

OnabotulinumtoxinA: Aminoglycosides may enhance the neuromuscular-blocking effect of OnabotulinumtoxinA. Risk C: Monitor therapy

Penicillins: May decrease the serum concentration of Aminoglycosides. Primarily associated with extended spectrum penicillins, and patients with renal dysfunction. Exceptions: Amoxicillin; Ampicillin; Cloxacillin; Dicloxacillin; Methicillin; Nafcillin; Oxacillin; Penicillin G (Parenteral/Aqueous); Penicillin G Benzathine; Penicillin G Procaine; Penicillin V Potassium. Risk D: Consider therapy modification

SEE MORE:  The Skinny on Fat-Soluble Vitamins

RimabotulinumtoxinB: Aminoglycosides may enhance the neuromuscular-blocking effect of RimabotulinumtoxinB. Risk C: Monitor therapy

Vancomycin: May enhance the nephrotoxic effect of Aminoglycosides. Risk C: Monitor therapy

PREGNANCY RISK FACTOR — C (show table)

PREGNANCY IMPLICATIONS — Reproduction studies have not been conducted with this combination; therefore, Bacitracin, Neomycin, and Polymyxin B is classified as pregnancy category C. See individual agents.

LACTATION — Excretion in breast milk unknown/use caution

BREAST-FEEDING CONSIDERATIONS — It is not known if bacitracin, neomycin, or polymyxin B is excreted into breast milk. The manufacturer recommends that caution be exercised when administering Bacitracin, Neomycin, and Polymyxin B to nursing women. See individual agents.

PRICING — (data from drugstore.com)
Ointment (Neomycin-Bacitracin Zn-Polymyx)
5-400-10000 (3.5): $7.99

INTERNATIONAL BRAND NAMES — Bamyxin (IL); Dactrol (ID); Multimycin (PE); My-B (TH); Neo-Polybacin (AE, BF, BH, BJ, CI, CY, EG, ET, GH, GM, GN, IL, IQ, IR, JO, KE, KW, LB, LR, LY, MA, ML, MR, MU, MW, NE, NG, OM, QA, SA, SC, SD, SL, SN, SY, TN, TZ, UG, YE, ZA, ZM, ZW); Neosporin Dermico (MX); Neosporin Ophthalmic Ointment (AU, IN); Novosporina (PY); Polixin Ungena (MX); Polysporin (BR); Terramycin Plus (PH); Tribiot (MX); Yentuogin (TW)

MECHANISM OF ACTION — See individual agents.

PHARMACODYNAMICS / KINETICS — See individual agents.