Superficial Bacterial Skin Infections
Neomycin sulfate in fixed combination with other anti-infectives (i.e., polymyxin B sulfate with or without bacitracin zinc) is used topically for the prevention of superficial bacterial skin infections associated with minor cuts, scrapes, or burns.107, 108, 109, 111, 112, 116, 141 Neomycin sulfate in fixed combination with other anti-infectives also has been used for the topical treatment † of minor skin infections caused by susceptible bacteria.116, 141, 144
Although minor skin infections and wounds usually heal without treatment, some minor skin wounds do not heal without treatment and it is impossible to determine at the time of injury which wounds will be self-healing. Some experts believe that, by reducing the number of superficial bacteria, topical anti-infectives are useful for preventing infection in minor skin injuries (e.g., cuts, scrapes, burns). The role, if any, of most topical anti-infectives for the treatment of superficial skin infections has not been fully elucidated, and systemic anti-infective therapy is required for the treatment of serious or extensive skin infections. Self-medication with topical anti-infectives for the prevention or treatment of superficial skin infections is not usually recommended.116
Infected Corticosteroid-responsive Dermatoses
Neomycin sulfate in fixed combination with a corticosteroid (i.e., fluocinolone acetonide, hydrocortisone, hydrocortisone acetate) with or without other anti-infectives (i.e., polymyxin B sulfate with or without bacitracin zinc) is used for the topical treatment of corticosteroid-responsive dermatoses with secondary infection.110, 113, 114
It has not been proven that fixed-combination topical preparations that include anti-infectives and a corticosteroid provide greater benefit than use of a topical corticosteroid alone after 7 days of treatment.110, 113, 114 The possible benefits of a fixed-combination topical preparation containing anti-infectives and a corticosteroid must be weighed against the risk that the corticosteroid may mask clinical signs of bacterial, fungal, or viral infections; prevent recognition of ineffectiveness of the anti-infective; or suppress hypersensitivity reactions to ingredients in the formulation.
Prevention of Bacteriuria Associated with Indwelling Catheters
Neomycin sulfate in fixed combination with polymyxin B sulfate is used for short-term (less than 10 days) continuous irrigation of the urinary bladder in abacteriuric patients for prevention of bacteriuria and gram-negative septicemia associated with the use of indwelling catheters.100, 144 However, routine bladder irrigation with anti-infectives is not recommended to prevent or eradicate catheter-associated bacteriuria in patients with indwelling catheters,120 and use of neomycin for bladder irrigation is no longer recommended.144 In one controlled study in patients with closed urinary catheter systems, bladder irrigation with the fixed combination of neomycin sulfate and polymyxin B sulfate did not decrease the incidence of bacteriuria compared to nonirrigation.
Neomycin has been used in the past for peritoneal instillation† and for irrigation of wounds or surgical sites†, but is no longer recommended for these uses because severe toxicity (e.g., ototoxicity) may occur.
For other uses of neomycin, see 8:12.02 and 52:04.04.
Neomycin sulfate in fixed combination with polymyxin B sulfate with or without bacitracin zinc is applied topically to the skin as an ointment.107, 109
Neomycin sulfate in fixed combination with a corticosteroid (i.e., fluocinolone acetonide, hydrocortisone, hydrocortisone acetate) with or without other anti-infectives (i.e., polymyxin B sulfate with or without bacitracin zinc) is applied topically to the skin as an ointment or cream.110, 113, 114
Neomycin sulfate also is commercially available in fixed combination with other anti-infectives (i.e., polymyxin B sulfate with or without bacitracin zinc) and a topical anesthetic (i.e., lidocaine hydrochloride, pramoxine hydrochloride) as ointments or creams for topical application to the skin.108, 111, 112
Fixed-combination topical preparations containing neomycin sulfate are for external use only on skin and should not be used in the eyes.107, 108, 109, 110, 111, 112, 113, 114
These topical preparations should not be applied to extensive areas of skin, deep or puncture wounds, animal bites, or serious burns.107, 108, 109, 111, 112, 114
A small amount of topical ointment or cream (amount equal to the surface area of a fingertip) should be applied to cleansed, affected areas of skin.107, 108, 109, 110, 111, 112, 113, 114
The treated areas of skin may be covered with a sterile bandage.107, 108, 109, 111, 112 However, at least one manufacturer of a topical preparation containing neomycin sulfate and a corticosteroid (i.e., fluocinolone acetonide) states that bandages and occlusive coverings should not be used on the treated areas of skin unless directed by a clinician.113
The commercially available irrigation solution concentrate containing a fixed combination of neomycin sulfate and polymyxin B sulfate is for continuous irrigation of the intact urinary bladder only and should not be used for irrigation of any other sites and should not be administered by injection or any other route.100
The irrigation solution concentrate must be diluted prior to use.100 The contents of a 1-mL ampul of the concentrate containing a fixed combination of neomycin sulfate and polymyxin B sulfate (40 mg of neomycin and 200,000 units of polymyxin B sulfate per mL) should be diluted in 1 L of 0.9% sodium chloride solution.100
The diluted irrigation solution should be administered by continuous bladder irrigation using a 3-way catheter;100 inflow of the diluted solution should not be interrupted for more than a few minutes.100
For most patients, the diluted irrigation solution should be administered by bladder irrigation using an inflow rate of 1 L every 24 hours.100 If the patient's urine output exceeds 2 L daily, the manufacturer recommends that the inflow rate be adjusted to 2 L every 24 hours.100
Prevention of Superficial Bacterial Skin Infections
For the prevention of superficial skin infections associated with minor cuts, scrapes, or burns, a small amount of fixed-combination ointment or cream containing neomycin sulfate should be applied to affected areas of skin 1-3 times daily.107, 108, 109, 111, 112
For self-medication , topical preparations containing neomycin sulfate may be used for up to 1 week.107, 108, 109, 111, 112 If the condition persists for longer than 1 week or worsens, a clinician should be contacted.107, 108, 109, 111, 112
Infected Corticosteroid-responsive Dermatoses
If a fixed-combination topical preparation containing neomycin sulfate and a corticosteroid (i.e., fluocinolone acetonide, hydrocortisone, hydrocortisone acetate) with or without other anti-infectives (i.e., polymyxin B sulfate with or without bacitracin zinc) is used for the topical treatment of corticosteroid-responsive dermatoses with secondary infection, a thin film or small amount of the ointment or cream should be applied to affected areas of skin 2-4 times daily.110, 113, 114 One manufacturer states that the topical preparation containing a corticosteroid should not be used for longer than 7 days.110
Prevention of Bacteriuria Associated with Indwelling Catheters
If the irrigation solution concentrate containing a fixed combination of neomycin sulfate and polymyxin B sulfate is used for the short-term prevention of bacteriuria associated with the use of indwelling catheters, adults may receive continuous bladder irrigation with 1 L of diluted solution (40 mg of neomycin and 200,000 units of polymyxin B sulfate in 1 L of 0.9% sodium chloride solution) by continuous bladder irrigation every 24 hours for up to 10 days.100 (See Bladder Irrigation under Dosage and Administration: Administration.)
Hypersensitivity reactions, including contact dermatitis, burning, erythema, rash, and urticaria, have occurred following topical application of neomycin sulfate in patients sensitive to the drug or other ingredients in the formulation. Rarely, anaphylactoid reactions have occurred with topical application of neomycin.
Topical neomycin is a known contact sensitizer, especially when used for prolonged periods. Sensitivity to topical neomycin has been reported to occur in 5-15% of patients treated with the drug.
Ototoxicity, nephrotoxicity, and neuromuscular blockade have occurred following topical application of neomycin resulting in systemic absorption of the drug, especially when used for peritoneal instillation†, irrigation of wounds or surgical sites, or topical treatment of skin ulcers, granulating wounds, serious burns, or extensive areas of denuded skin†. Rarely, death has occurred following topical application of the drug.
Following systemic absorption of neomycin, toxicity is most likely to occur in patients with renal impairment, infants, dehydrated individuals, geriatric individuals, and patients receiving high doses for prolonged periods. The possibility of cumulative toxicity should be considered when neomycin is applied topically in combination with systemic aminoglycoside therapy.
Precautions and Contraindications
Topical preparations containing neomycin sulfate should not be used by patients hypersensitive to the drug or any ingredient in the formulation.107, 108, 109, 111, 112 (See Precautions Related to Sensitivity Reaction under Cautions: Precautions and Contraindications.)
The fixed-combination topical preparations containing neomycin sulfate and a corticosteroid (i.e., fluocinolone acetonide, hydrocortisone, hydrocortisone acetate) with or without other anti-infectives (i.e., polymyxin B sulfate with or without bacitracin zinc) are contraindicated in patients hypersensitive to any ingredient in the formulation.110, 113, 114 These fixed combinations also are contraindicated in patients with tuberculous, fungal, or viral (e.g., herpes simplex, varicella zoster) skin lesions110, 114 and are contraindicated for use in the eyes or in the external ear canal if the eardrum is perforated.110, 113, 114
The irrigation solution concentrate containing a fixed combination of neomycin sulfate and polymyxin B sulfate is contraindicated in patients hypersensitive to neomycin, polymyxins, or any ingredient in the formulation.100 Because of cross-sensitivity among the aminoglycosides, the irrigation solution may also be contraindicated in patients with a history of hypersensitivity or serious toxic reaction to any aminoglycoside.100
Precautions Related to Sensitivity Reactions
Patients should be advised to discontinue topical preparations containing neomycin sulfate and contact a clinician if itching, burning, rash, or any other signs of sensitivity or allergic reaction occur.107, 108, 109, 110, 111, 112, 113
Clinicians should consider that patients allergic to topical neomycin sulfate may have cutaneous sensitivity reactions or anaphylactic reactions to the drug.110, 141
Cross-allergenicity occurs among the aminoglycosides and the possibility that patients who become sensitized to topical neomycin may also be sensitive to other topical and/or systemic aminoglycosides should be considered.110
Patients allergic to one fixed-combination topical preparation containing neomycin sulfate should avoid preparations containing any of the component drugs.
Precautions Related to Topical Use
Patients should be informed that topical preparations containing neomycin sulfate are intended for external use only and should not be used in the eyes or applied over large areas of the body.107, 108, 109, 110, 111, 112, 113
Patients using topical preparations containing neomycin sulfate for self-medication for the prevention of infection in minor skin injuries (e.g., cuts, scrapes, burns) should be advised that these topical preparations should not be used for longer than 1 week unless directed by a clinician and to discontinue use of the topical anti-infective preparation and consult a clinician if the condition persists or worsens.107, 108, 109, 111, 112
Patients should be advised to first consult a clinician if considering self-medication with a topical anti-infective for deep or puncture wounds, animal bites, or serious burns.107, 108, 109, 111, 112
Prolonged use of topical anti-infectives, including neomycin sulfate, may promote bacterial resistance and should be avoided.110, 141, 144 Overgrowth of nonsusceptible organisms, including fungi, may occur.110
Because of the risk of systemic absorption and possibility of severe toxicity (ototoxicity, nephrotoxicity, neuromuscular blockade), topical neomycin should be used with caution for the treatment of extensive burns, trophic ulceration, or other extensive dermatologic conditions where rapid absorption of the drug is possible. Topical neomycin should be applied no more than once daily in the treatment of patients with burns covering more than 20% of their body surface area, especially if such patients have impaired renal function or are receiving other aminoglycosides concurrently.
Precautions Related to Bladder Irrigation
The irrigation solution concentrate containing a fixed combination of neomycin sulfate and polymyxin B sulfate should not be used if there is a possibility of systemic absorption.100 The irrigation solution is intended for continuous prophylactic bladder irrigation only in patients with an intact urinary bladder.100 Because of the risk of systemic absorption and toxicity (e.g., ototoxicity, nephrotoxicity, neuromuscular blockade), bladder irrigation with the fixed combination should be avoided in patients with defects in the bladder mucosa or bladder wall (e.g., vesical rupture) and should not be used in conjunction with operative procedures involving the bladder wall.100 Patients with impaired renal function, infants, dehydrated patients, geriatric patients, and those receiving prolonged treatment with high doses are especially at risk for toxicity.100
Safety and efficacy of the irrigation solution containing neomycin sulfate and polymyxin B sulfate have not been established in patients with recent lower urinary tract surgery.100
Bladder irrigation with the fixed combination of neomycin sulfate and polymyxin B sulfate may result in overgrowth of nonsusceptible organisms, including fungi, and appropriate measures should be taken if this occurs.100
Urine specimens for urinalysis, culture, and susceptibility testing should be collected during prophylactic bladder irrigation with the fixed combination.100 If uropathogens are isolated, in vitro susceptibility testing should be performed and systemic anti-infective therapy initiated if appropriate.100
Precautions Related to Use of Fixed Combinations
When neomycin sulfate is used topically in fixed combination with other topical anti-infectives (i.e., polymyxin B sulfate with or without bacitracin zinc), topical corticosteroids (i.e., fluocinolone acetonide, hydrocortisone, hydrocortisone acetate), or topical anesthetics (i.e., lidocaine hydrochloride, pramoxine hydrochloride), the cautions, precautions, and contraindications associated with each drug in the fixed combination should be considered.
When fixed-combination topical preparations containing neomycin sulfate and a corticosteroid with or without other anti-infectives are used, clinicians should consider that topical corticosteroids used in fixed combination with topical anti-infectives may mask the clinical signs of bacterial, fungal, or viral infections, or may suppress hypersensitivity reactions to the anti-infectives or other ingredients in the formulation.144 Clinicians also should consider that use of topical corticosteroids can result in signs and symptoms of exogenous hyperadrenocorticism, including adrenal suppression, and that systemic absorption of topically applied corticosteroids is increased if extensive body surface areas are treated or if occlusive dressings are used.110, 113, 114 Patients using a fixed-combination topical preparation containing a corticosteroid should be advised to discontinue use and contact a clinician if redness, irritation, swelling, or pain persists or increases.110, 113, 114
Some manufacturers state that topical preparations containing neomycin sulfate and other anti-infectives should not be used in children younger than 2 years of age unless directed by a clinician.108, 111
The manufacturer of the topical preparation containing neomycin sulfate and fluocinolone acetonide states that use of topical corticosteroids in children should be limited to the least amount compatible with an effective treatment regimen and cautions that pediatric patients may be more susceptible to topical corticosteroid-induced hypothalamic-pituitary-adrenal (HPA) axis suppression and Cushing's syndrome than more mature patients because of a larger skin surface area to body weight ratio.113
The manufacturer states that safety and efficacy of topical preparations containing neomycin sulfate, a corticosteroid (i.e., hydrocortisone or hydrocortisone acetate), and other anti-infectives (i.e., polymyxin B sulfate with or without bacitracin zinc) have not been established in pediatric patients.110, 114 If topical hydrocortisone is used for prolonged periods in infants and children, sufficient percutaneous absorption of the drug can occur and cause cessation of growth, as well as other signs and symptoms of hyperadrenocorticism.110
At least one manufacturer of a topical preparation containing neomycin sulfate, polymyxin B sulfate, bacitracin zinc, and a topical anesthetic (i.e., lidocaine hydrochloride) states that the preparation should not be used in children younger than 12 years of age unless directed by a clinician.112
Safety and efficacy of the irrigation solution concentrate containing neomycin sulfate and polymyxin B sulfate have not been established in pediatric patients.100
Although clinical studies evaluating topical preparations containing neomycin sulfate, other anti-infectives (i.e., polymyxin B sulfate with or without bacitracin zinc), and a corticosteroid (i.e., hydrocortisone or hydrocortisone acetate) did not include sufficient numbers of patients 65 years of age or older to determine whether geriatric individuals respond differently than younger patients, other reported clinical experience has not identified differences in responses between geriatric and younger patients.110, 114
Geriatric patients receiving prolonged bladder irrigation with high doses of the irrigation solution containing neomycin sulfate and polymyxin B sulfate may be at increased risk for toxicity.100
Aminoglycosides may cause fetal harm following systemic absorption in pregnant women.100 The drugs cross the placenta and total, irreversible, bilateral, congenital deafness has been reported in some children whose mothers received parenteral streptomycin during pregnancy.100
Fixed-combination topical preparations containing neomycin sulfate and a corticosteroid should be used during pregnancy only if potential benefits justify potential risks to the fetus.110, 113, 114 Corticosteroids have been teratogenic in animals (mice, rabbits) when applied topically.110, 113, 114
If the irrigation solution containing neomycin sulfate and polymyxin B sulfate is used for bladder irrigation during pregnancy, the patient should be informed of the potential hazard to the fetus.100
Clinically unimportant amounts of neomycin may distribute into breast milk following systemic absorption of the drug.140
Fixed-combination topical preparations containing neomycin sulfate and a corticosteroid should be used with caution in nursing women.110, 113, 114 Corticosteroids administered systemically (e.g., orally) are distributed into human milk,110, 113, 114 and systemic absorption may occur when the drugs are applied topically.110, 114
Neomycin usually is bactericidal in action. Although the exact mechanism of action has not been fully elucidated, the drug appears to inhibit protein synthesis in susceptible bacteria by irreversibly binding to 30S ribosomal subunits.
In general, neomycin is active against some aerobic gram-positive bacteria and many gram-negative bacteria.141, 144 The drug is inactive against fungi, viruses, and most anaerobic bacteria.
In vitro, neomycin concentrations of 1-12.5 mcg/mL inhibit most susceptible strains of Staphylococcus aureus , S. epidermidis , Escherichia coli , Haemophilus influenzae , Moraxella lacunata , and indole-positive and indole-negative Proteus . However, different species and different strains of the same species may exhibit wide variations in susceptibility in vitro. Streptococci, enterococci, Serratia , Pseudomonas aeruginosa , and anaerobic bacteria generally are resistant to neomycin.
Natural and acquired resistance to neomycin have been demonstrated in both gram-positive and gram-negative bacteria.141, 144 Resistance to neomycin may be the result of decreased permeability of the bacterial cell wall, alterations in the ribosomal binding site, or the presence of a plasmid-mediated resistance factor which is acquired by conjugation. Plasmid-mediated resistance enables the resistant bacteria to enzymatically modify the drug by acetylation, phosphorylation, or adenylylation and can be transferred between organisms of the same or different species. Resistance to other aminoglycosides and several other anti-infectives (e.g., chloramphenicol, sulfonamides, tetracycline) may be transferred on the same plasmid.
There is partial cross-resistance between neomycin and other aminoglycosides; cross-resistance occurs frequently between kanamycin, neomycin, and paromomycin.
Neomycin sulfate is not absorbed following topical application to intact skin;141 however, the drug is readily absorbed through denuded or abraded areas of skin or skin that has lost the keratin layer as in wounds, burns, or ulcers.
Following irrigation of the intact urinary bladder with the irrigation solution containing a fixed combination of neomycin sulfate and polymyxin B sulfate, systemic absorption of the drugs is not expected to be clinically important if the duration of bladder irrigation does not exceed 10 days.100 Systemic absorption of neomycin may occur if the bladder surface is denuded or inflamed.100, 144
Neomycin is rapidly absorbed from the peritoneum, draining sinuses, wounds, or surgical sites; use of large doses at these sites may result in substantial plasma concentrations of the drug.
Neomycin is an aminoglycoside antibiotic obtained from cultures of Streptomyces fradiae .141, 144 The drug may be a mixture of neomycin A (neamine), neomycin B, and neomycin C and these components have various degrees of antimicrobial activity. The commercially available drug is comprised almost entirely of the sulfate salt of neomycin B and occurs as a white to slightly yellow, hygroscopic powder or cryodesiccated solid and is freely soluble in water and very slightly soluble in alcohol.
Fixed-combination topical preparations containing neomycin sulfate and other anti-infectives (i.e., polymyxin B sulfate with or without bacitracin zinc) should be stored at 20-25107 or 15-30°C,109 depending on the manufacturer.
Fixed-combination topical preparations containing neomycin sulfate and a corticosteroid (i.e., fluocinolone acetonide, hydrocortisone, hydrocortisone acetate) with or without other anti-infectives (i.e., polymyxin B sulfate with or without bacitracin zinc) should be stored at 15-25°C;110, 113, 114 exposure to excessive heat (greater than 40°C) or freezing should be avoided.113
Fixed-combination topical preparations containing neomycin sulfate and a local anesthetic (i.e., lidocaine hydrochloride, pramoxine hydrochloride) with polymyxin B sulfate with or without bacitracin zinc should be stored at 20-25108 or 15-30°C,111, 112 depending on the manufacturer; some manufacturers state that these preparations should be protected from excessive heat111, 112 and freezing.111
The irrigation solution concentrate containing a fixed combination of neomycin sulfate and polymyxin B sulfate should be stored at 2-8°C.100 Following dilution in 0.9% sodium chloride, the irrigation solution should be stored at 4°C and used within 48 hours after dilution.100
Neomycin sulfate preparations may be discolored by light. Although discoloration does not appear to affect potency, neomycin sulfate preparations should be stored in light-resistant containers. Neomycin is adsorbed to cellulose, diatomaceous earth and seitz filters, and large amounts of the drug may be removed if neomycin sulfate solutions are filtered.
Additional Information
The American Society of Health-System Pharmacists, Inc. represents that the information provided in the accompanying monograph was formulated with a reasonable standard of care, and in conformity with professional standards in the field. Readers are advised that decisions regarding use of drugs are complex medical decisions requiring the independent, informed decision of an appropriate health care professional, and that the information contained in the monograph is provided for informational purposes only. The manufacturer's labeling should be consulted for more detailed information. The American Society of Health-System Pharmacists, Inc. does not endorse or recommend the use of any drug. The information contained in the monograph is not a substitute for medical care.
Excipients in commercially available drug preparations may have clinically important effects in some individuals; consult specific product labeling for details.
Please refer to the ASHP Drug Shortages Resource Center for information on shortages of one or more of these preparations.
Routes | Dosage Forms | Strengths | Brand Names | Manufacturer |
|---|---|---|---|---|
Urogenital | For irrigation, concentrate | Neosporin Sulfate 40 mg (of neomycin) per mL and Polymyxin B Sulfate 200,000 units per mL* | Neomycin and Polymyxin B Sulfates Solution for Irrigation | |
Neosporin® G.U. Irrigant |
* available from one or more manufacturer, distributor, and/or repackager by generic (nonproprietary) name
Routes | Dosage Forms | Strengths | Brand Names | Manufacturer |
|---|---|---|---|---|
Topical | Ointment | Neomycin Sulfate 3.5 mg (of neomycin) per g, Polymyxin B Sulfate 5000 units (of polymyxin B) per g, and Bacitracin Zinc 400 units (of bacitracin) per g* | Neomycin and Polymyxin B Sulfates and Bacitracin Zinc Ointment | |
Neosporin® Original | Johnson & Johnson | |||
* available from one or more manufacturer, distributor, and/or repackager by generic (nonproprietary) name
Routes | Dosage Forms | Strengths | Brand Names | Manufacturer |
|---|---|---|---|---|
Topical | Ointment | Neomycin Sulfate 3.5 mg (of neomycin) per g, Polymyxin B Sulfate 5000 units (of polymyxin B) per g, Bacitracin Zinc 400 units (of bacitracin) per g, and Hydrocortisone 1% | Cortisporin® Ointment | Pfizer |
Routes | Dosage Forms | Strengths | Brand Names | Manufacturer |
|---|---|---|---|---|
Topical | Cream | Neomycin Sulfate 3.5 mg (of neomycin) per g, Polymyxin B Sulfate 10,000 units (of polymyxin B) per g, and Hydrocortisone Acetate 5 mg per g | Cortisporin® Cream | Pfizer |
Routes | Dosage Forms | Strengths | Brand Names | Manufacturer |
|---|---|---|---|---|
Topical | Cream | Neomycin Sulfate 3.5 mg (of neomycin) per g and Fluocinolone Acetonide 0.25 mg per g | Neo-Synalar® | Medimetriks |
Routes | Dosage Forms | Strengths | Brand Names | Manufacturer |
|---|---|---|---|---|
Topical | Cream | Neomycin Sulfate 3.5 mg (of neomycin) per g, Polymyxin B Sulfate 5000 units (of polymyxin B) per g, Bacitracin Zinc 400 units (of bacitracin) per g, and Lidocaine Hydrochloride 20 mg per g* | Neomycin and Polymyxin B Sulfates, Bacitracin Zinc, and Lidocaine Hydrochloride Cream | |
Neomycin Sulfate 3.5 mg (of neomycin) per g, Polymyxin B Sulfate 10,000 units (of polymyxin B) per g, and Pramoxine Hydrochloride 10 mg per g* | Neomycin Sulfate, Polymyxin B Sulfate, and Pramoxine Hydrochloride Cream | |||
Ointment | Neomycin Sulfate 3.5 mg (of neomycin) per g, Polymyxin B Sulfate 5000 units per g, Bacitracin Zinc 400 units per g, and Lidocaine 40 mg per g* | Neomycin and Polymyxin B Sulfates, Bacitracin Zinc, and Lidocaine Ointment | ||
Neomycin Sulfate 3.5 mg (of neomycin) per g, Polymyxin B Sulfate 10,000 units (of polymyxin B) per g, Bacitracin Zinc 500 units (of bacitracin) per g, and Pramoxine Hydrochloride 10 mg per g* | Neomycin Sulfate, Polymyxin B Sulfate, Bacitracin Zinc, and Pramoxine Hydrochloride Ointment | |||
Triple Antibiotic Plus | ||||
Neosporin® Plus | Johnson & Johnson |
* available from one or more manufacturer, distributor, and/or repackager by generic (nonproprietary) name
100. Pfizer. Neosporin® G.U. Irrigant Sterile (neomycin sulfate-polymyxin B sulfate solution for irrigation) prescribing information. New York, NY; 2016 Sep.
107. Johnson & Johnson. Neosporin® Original (bacitracin zinc, neomycin sulfate, and polymyxin B sulfate) ointment patient information. Skillman, NJ; Undated. From Dailymed website. Accessed 2020 Jan 15.
108. Johnson & Johnson. Neosporin® Plus (bacitracin zinc, neomycin sulfate, polymyxin B sulfate, and pramoxine hydrochloride) ointment patient information. Skillman, NJ; Undated. From Dailymed website. Accessed 2020 Jan 15.
109. Actavis Pharma. Triple Antibiotic (bacitracin zinc, neomycin sulfate, and polymyxin B sulfate) ointment patient information. Parsippany, NJ; Undated. From Dailymed website. Accessed 2020 Jan 15.
110. Pfizer Laboratories. Cortisporin® (neomycin and polymyxin B sulfates, bacitracin zinc, and hydrocortisone) ointment prescribing information. New York, NY; 2016 Aug.
111. CellNovation Technology. Bacitracin zinc, neomycin sulfate, polymyxin B sulfate, and lidocaine hydrochloride cream patient information. Undated. From Dailymed website. Accessed 2020 Jan 15.
112. Hart Health. (bacitracin zinc, neomycin sulfate, polymyxin B sulfate, and lidocaine) ointment patient information. Seattle, WA; Undated. From Dailymed website. Accessed 2020 Jan 15.
113. Medimetriks Pharmaceuticals. Neo-Synalar® (neomycin sulfate and fluocinolone acetonide) cream prescribing information. Fairfield, NJ; 2016 Sep.
114. Pfizer Laboratories. Cortisporin® (neomycin sulfate, polymyxin B sulfate, and hydrocortisone acetate) cream prescribing information. New York, NY; 2016 Aug.
116. Williamson DA, Carter GP, Howden BP. Current and Emerging Topical Antibacterials and Antiseptics: Agents, Action, and Resistance Patterns. Clin Microbiol Rev . 2017; 30:827-860. [PubMed 28592405]
120. Hooton TM, Bradley SF, Cardenas DD et al. Diagnosis, prevention, and treatment of catheter-associated urinary tract infection in adults: 2009 International Clinical Practice Guidelines from the Infectious Diseases Society of America. Clin Infect Dis . 2010; 50:625-63. Updates may be available at IDSA website at www.idsociety.org. [PubMed 20175247]
140. Briggs GG, Freeman RK, Yaffe SJ. Drugs in pregnancy and lactation. 6th ed. Philadelphia: Lippincott Williams & Wilkins; 2002: 983/n-4/n.
141. O'Donnell JA, Gelone SP, and Safdar M. Topical antibacterials. In: Bennett JE, Dolin R, and Blaser MJ, eds. Mandell, Douglas, and Bennett's principles and practices of infectious diseases. 8th ed. Philadelphia, PA: Elsevier Saunders; 2015:1844-80.
144. Mouton JW. Neomycin. In: Grayson ML, ed. Kucers' the use of antibiotics: a clinical review of antibacterial, antifungal, antiparasitic, and antiviral drugs. 7th ed. Boca Raton, FL: CRC Press; 2018: 1046-52.