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|Neomycin Sulfate/Polymyxin B Sulfate/Gramicidin

Neomycin Sulfate/Polymyxin B Sulfate/Gramicidin

Trade Names:
Neosporin
- Ophthalmic Solution 10,000 units/mL polymyxin B sulfate, 1.75 mg/mL neomycin, and 0.025 mg/mL gramicidin

Mechanism of Action

Pharmacology

Inhibits protein synthesis by binding to ribosomal RNA, causing bacterial genetic code misreading.

Interacts with phospholipid components of bacterial cell membranes, increasing cell wall permeability.

Increases the permeability of the bacterial cell wall to inorganic cations by forming a network of channels through the normal lipid bilayer of the membrane.

Indications and Usage

Topical treatment of superficial infections of the external eye and its adnexa caused by susceptible bacteria.

Contraindications

Hypersensitivity to any component of the product.

Dosage and Administration

Ophthalmic Instill 1 or 2 drops into the affected eye every 4 h for 7 to 10 days. In severe infections, the dosage may be increased to as many as 2 drops every h.

General Advice

• For ophthalmic use only. Not for use in the ears or on the skin.
• Do not allow tip of dropper bottle to touch eye, eyelid, fingers, or any other surface.
• If using other topical ophthalmic medications, instill drops first, wait at least 5 min, and instill ointment last.

Storage/Stability

Store at controlled room temperature (59° to 86°F). Keep bottle tightly capped and protect from light.

Drug Interactions

None well documented.

Laboratory Test Interactions

None well documented.

Adverse Reactions

EENT

Hypersensitivity, including itching, swelling, and conjunctival erythema; local irritation.

Miscellaneous

Allergic hypersensitivity, including anaphylaxis.

Precautions

Pregnancy

Category C .

Lactation

Undetermined.

Children

Safety and efficacy not established.

Superinfection

Prolonged use may result in bacterial or fungal overgrowth of nonsusceptible microorganisms.

Bacterial keratitis

Has been reported with use of topical ophthalmic products in multiple-dose containers that have been inadvertently contaminated by patients who frequently had concurrent corneal disease or a disruption of the ocular epithelial surface.

Bacterial resistance

May develop.

Cross-sensitivity

Allergic cross-sensitivity to kanamycin, paromomycin, streptomycin, and possible gentamicin may occur.

Patient Information

• Explain name, dose, action, and potential side effects of drug.
• Review prescribed dosing schedule with patient, family, or caregiver.
• Remind patient, family, or caregiver that solution is for use in the eye only.
• Teach patient, family, or caregiver proper technique for instilling solution: wash hands; do not allow tip of dropper bottle to touch eye, eyelid, fingers, or any other surface. Tilt head back and look up; pull lower eyelid down to form pocket; place prescribed number of drops in the pocket. Look downward before closing eye. Do not rub eye.
• Advise patient, family, or caregiver that if more than 1 topical ophthalmic drug is being used, instill eye drops first, wait at least 5 min, and then instill ointment last.
• Inform patient that temporary blurred vision and stinging of the eye are the most common side effects and to contact health care provider if they occur and are bothersome.
• Advise patient to contact eye doctor if eye or eyelid inflammation is noted or if eye symptoms do not improve or worsen.
• Advise patient that the entire course of therapy must be completed to ensure maximal benefit and to complete full course of therapy even if symptoms have resolved.
• Instruct patient not to wear contact lenses during treatment.
• Remind patient, family, or caregiver that follow-up eye examinations may be necessary while using this medication and to keep appointments.