neomycin

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.

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.

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].

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).

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.

Classifications ⬆ ⬇

Therapeutic Classification: anti-infectives

Pharmacologic Classification: aminoglycosides

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

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.

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Indications ⬇