neomycin

Therapeutic Classification: anti-infectives

Pharmacologic Classification: aminoglycosides

Indications ⬆ ⬇

REMS

Preparation of the GI tract for surgery.
Treatment of diarrhea caused by Escherichia coli.
To decrease the number of ammonia-producing bacteria in the gut as part of the management of hepatic encephalopathy.

Action ⬆ ⬇

Inhibits protein synthesis in bacteria at level of 30S ribosome.

Therapeutic effects:

Bactericidal action.

Spectrum:

Notable for activity against:
- Klebsiella pneumoniae,
- Escherichia coli,
- Proteus,
- Serratia,
- Acinetobacter,
- Staphylococcus aureus.

Pharmacokinetics ⬆ ⬇

Absorption: Minimal systemic absorption, but may accumulate in patients with renal failure.

Distribution: Widely distributed throughout extracellular fluid; crosses the placenta; small amounts enter breast milk. Poor penetration into CSF.

Metabolism/Excretion: Excretion is >90% renal.

Half-Life: 2–4 hr (increased in renal impairment).

Time/Action Profile ⬆ ⬇

(blood levels)

ROUTE	ONSET	PEAK	DURATION
PO	rapid	1–4 hr	N/A

Contraind./Precautions ⬆ ⬇

Contraindicated in:

Hypersensitivity to neomycin or other aminoglycosides;
Intestinal obstruction.

Use Cautiously in:

Renal impairment (lower doses are recommended);
Hearing impairment;
Geri: Geriatric patients;
Neuromuscular diseases such as myasthenia gravis;
OB: Safety not established;
Pedi: Safety not established.

Adv. Reactions/Side Effects ⬆ ⬇

GI: diarrhea, nausea, vomiting

Misc: hypersensitivity reactions

Interactions ⬆ ⬇

Interactions are listed for systemically absorbed drug

Drug-drug:

May enhance possible respiratory paralysis after inhalation anesthetics orneuromuscular blockers.
↑incidence of ototoxicity with loop diuretics.
↑incidence of nephrotoxicity with other nephrotoxic drugs.
May ↑anticoagulant effects of warfarin.
May ↓absorption of digoxin and methotrexate.

Route/Dosage ⬆ ⬇

Preoperative Intestinal Antisepsis

PO (Adults ): 1 g every hr for 4 doses, then 1 g every 4 hr for 5 doses or 1 g at 1 PM, 2 PM, and 11 PM on day before surgery.
PO (Children ): 15 mg/kg every 4 hr for 2 days or 25 mg/kg at 1 PM, 2 PM, and 11 PM on day before surgery.

Hepatic Encephalopathy

PO (Adults ): 1–3 g every 6 hr for 5–6 days; may be followed by 4 g/day chronically.
PO (Children ): 12.5–25 mg/kg every 6 hr for 5–6 days (max dose 12 g/day).

Availability ⬆ ⬇

(Generic available)

Tablets: 500 mg
In combination with: other topical antibiotics or anti-inflammatory agents for skin, ear, and eye infections. See Appendix [not included in this PDA edition].

Assessment ⬆ ⬇

Assess patient for infection (vital signs, wound appearance, sputum, urine, stool, WBC) at beginning of and throughout therapy.
Hepatic Encephalopathy: Monitor neurologic status. Prior to administering oral medication, assess patient's ability to swallow.

Implementation ⬆ ⬇

Keep patient well hydrated (1500–2000 mL/day) during therapy.
Preoperative Bowel Prep: Neomycin is usually used in conjunction with erythromycin, a low-residue diet, and a cathartic or enema.
PO: May be administered without regard to meals.

Patient/Family Teaching ⬆ ⬇

Advise patient of the importance of drinking plenty of liquids.
PO: Instruct patient to take as directed for full course of therapy. Missed doses should be taken as soon as possible if not almost time for next dose; do not double doses.
- Caution patient that medication may cause nausea, vomiting, or diarrhea.

Evaluation/Desired Outcomes ⬆

Resolution of the signs and symptoms of infection. If no response is seen within 3–5 days, new cultures should be taken.
Prevention of infection in intestinal surgery.
Improved neurologic status in hepatic encephalopathy.

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Pronunciation ⬇

Classifications ⬆ ⬇