Yes

Ammonium Detoxicant; Antibiotic, Aminoglycoside; Antibiotic, Topical

Orally to prepare GI tract for surgery; topically to treat minor skin infections; treat diarrhea caused by E. coli; adjunct in the treatment of hepatic encephalopathy

C

Hypersensitivity to neomycin or any component, or other aminoglycosides; patients with intestinal obstruction

Use with caution in patients with renal impairment, pre-existing hearing impairment, neuromuscular disorders; neomycin is more toxic than other aminoglycosides when given parenterally; do not administer parenterally; topical neomycin is a contact sensitizer with sensitivity occurring in 5% to 15% of patients treated with the drug; symptoms include itching, reddening, edema, and failure to heal; do not use as peritoneal lavage due to significant systemic adsorption of the drug

1% to 10%:

Dermatologic: Dermatitis, rash, urticaria, erythema

Local: Burning

Ocular: Contact conjunctivitis

<1%: Nausea, vomiting, diarrhea, neuromuscular blockade, ototoxicity, nephrotoxicity

Symptoms of overdose (rare due to poor oral bioavailability) include ototoxicity, nephrotoxicity, and neuromuscular toxicity

The treatment of choice following a single acute overdose appears to be the maintenance of good urine output of at least 3 mL/kg/hour. Dialysis is of questionable value in the enhancement of aminoglycoside elimination. If required, hemodialysis is preferred over peritoneal dialysis in patients with normal renal function. Chelation with penicillin may be of benefit.

Decreased effect: May decrease GI absorption of digoxin and methotrexate

Increased effect: Synergistic effects with penicillins

Increased toxicity:

Oral neomycin may potentiate the effects of oral anticoagulants

Increased adverse effects with other neurotoxic, ototoxic, or nephrotoxic drugs

Use reconstituted parenteral solutions within 7 days of mixing, when refrigerated

Interferes with bacterial protein synthesis by binding to 30S ribosomal subunits

Absorption: Oral, percutaneous: Poor (3%)

Distribution: V_d: 0.36 L/kg

Metabolism: Slight hepatic

Half-life: 3 hours (age and renal function dependent)

Time to peak serum concentration: Oral: 1-4 hours; I.M.: Within 2 hours

Elimination: In urine (30% to 50% as unchanged drug); 97% of an oral dose eliminated unchanged in feces

Children: Oral:

Preoperative intestinal antisepsis: 90 mg/kg/day divided every 4 hours for 2 days; or 25 mg/kg at 1 PM, 2 PM, and 11 PM on the day preceding surgery as an adjunct to mechanical cleansing of the intestine and in combination with erythromycin base

Hepatic coma: 50-100 mg/kg/day in divided doses every 6-8 hours or 2.5-7 g/m²/day divided every 4-6 hours for 5-6 days not to exceed 12 g/day

Children and Adults: Topical: Apply ointment 1-4 times/day; topical solutions containing 0.1% to 1% neomycin have been used for irrigation

Adults: Oral:

Preoperative intestinal antisepsis: 1 g each hour for 4 doses then 1 g every 4 hours for 5 doses; or 1 g at 1 PM, 2 PM, and 11 PM on day preceding surgery as an adjunct to mechanical cleansing of the bowel and oral erythromycin; or 6 g/day divided every 4 hours for 2-3 days

Hepatic coma: 500-2000 mg every 6-8 hours or 4-12 g/day divided every 4-6 hours for 5-6 days

Chronic hepatic insufficiency: 4 g/day for an indefinite period

Hemodialysis: Dialyzable (50% to 100%)

Renal function tests, audiometry in symptomatic patients

None reported

None reported

No information available to require special precautions

No effects or complications reported

Oral: Take as directed. Maintain adequate hydration (2-3 L/day of fluids unless instructed to restrict fluid intake). You may experience nausea or vomiting (small frequent meals, frequent mouth care, sucking lozenges, or chewing gum may help); constipation (exercise, increased fluid or fiber in diet may help, or consult prescriber); or diarrhea (buttermilk, boiled milk, or yogurt may help). Report immediately any change in hearing,; ringing or sense of fullness in ears; persistent diarrhea; changes in voiding patterns; or numbness, tingling, or pain in any extremity. Pregnancy/breast-feeding precautions: Inform prescriber if you are or intend to be pregnant. Consult prescriber if breast-feeding.

Topical: Apply a thin film of cream or ointment; do not overuse. Report rash, itching, redness, or failure of condition to improve.

Cream, as sulfate: 0.5% (15 g)

Injection, as sulfate: 500 mg

Ointment, topical, as sulfate: 0.5% (15 g, 30 g, 120 g)

Solution, oral, as sulfate: 125 mg/5 mL (480 mL)

Tablet, as sulfate: 500 mg [base 300 mg]

Begg EJ and Barclay ML, "Aminoglycosides - 50 Years On," Br J Clin Pharmacol, 1995, 39(6):597-603.

Edson RS and Terrell CL, "The Aminoglycosides," Mayo Clin Proc, 1991, 66(11):1158-64.

Feigin RD and Cherry JD, Textbook of Pediatric Infectious Diseases, 4th ed, Philadelphia, PA: WB Saunders Co, 1997.