Professional Information
Neomycin (Topical)
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VA CLASSIFICATION
Primary: DE101{03}
Commonly used brand name(s): Myciguent.
Note: For a listing of dosage forms and brand names by country availability, see Dosage Forms section(s).
†Not commercially available in Canada.
Category:
Antibacterial (topical){07}—
Indications
Note: Bracketed information in the Indications section refers to uses that are not included in U.S. product labeling.
Accepted
Skin infections, bacterial, minor (prophylaxis)—Topical neomycin is indicated in the prophylaxis of superficial infections in minor abrasions, burns, and cuts. {01} {05} {12}
[Skin infections, bacterial, minor (treatment)] or{01}{02}
[Ulcer, dermal (treatment)]—Topical neomycin is used in the treatment of minor bacterial skin infections and dermal ulcer. {01}
—Not all species or strains of a particular organism may be susceptible to neomycin.
Unaccepted
Neomycin is not effective against Pseudomonas aeruginosa {11}.
Pharmacology/Pharmacokinetics
Physicochemical characteristics:
Chemical group—
Aminoglycosides {11}
Mechanism of action/Effect:
Actively transported across the bacterial cell membrane, binds to a specific receptor protein on the 30 S subunit of bacterial ribosomes, and interferes with an initiation complex between mRNA (messenger RNA) and the 30 S subunit, inhibiting protein synthesis. DNA may be misread, thus producing nonfunctional proteins; polyribosomes are split apart and are unable to synthesize protein. {11}
Note: Aminoglycosides are bactericidal, while most other antibiotics that interfere with protein synthesis are bacteriostatic.
Absorption:
Although not absorbed through intact skin, topical neomycin is readily absorbed from large denuded, burned, or granulating areas. {09} Greater and more rapid absorption occurs with neomycin cream than with the ointment.
Precautions to Consider
Cross-sensitivity and/or related problems
Patients sensitive to one aminoglycoside may be sensitive to other aminoglycosides also. {09}
Pregnancy/Reproduction
Pregnancy—
Problems in humans have not been documented.
Breast-feeding
It is not known whether topical neomycin is distributed into breast milk. However, problems in humans have not been documented.
Pediatrics
No information is available on the relationship of age to the effects of topical neomycin in pediatric patients.
Geriatrics
No information is available on the relationship of age to the effects of topical neomycin in geriatric patients.
Drug interactions and/or related problems
The following drug interactions and/or related problems have been selected on the basis of their potential clinical significance (possible mechanism in parentheses where appropriate)—not necessarily inclusive (» = major clinical significance):
Note: Combinations containing any of the following medications, depending on the amount present, may also interact with this medication.
Aminoglycosides, other (concurrent topical and systemic use of neomycin or related drugs is not recommended since hypersensitivity reactions may occur more frequently during concurrent use; if significant systemic absorption occurs, hearing loss may also result; this may progress to deafness even after discontinuation of the drug, and may be permanent {11})
Medical considerations/Contraindications
The medical considerations/contraindications included have been selected on the basis of their potential clinical significance (reasons given in parentheses where appropriate)— not necessarily inclusive (» = major clinical significance).
Risk-benefit should be considered when the following medical problem exists
Sensitivity to aminoglycosides{02}
Side/Adverse Effects
The following side/adverse effects have been selected on the basis of their potential clinical significance (possible signs and symptoms in parentheses where appropriate)—not necessarily inclusive:
Those indicating need for medical attention {11}
Incidence more frequent
Contact dermatitis (itching, rash, redness, swelling, or other sign of skin irritation not present before therapy)
Incidence rare
Ototoxicity (any loss of hearing)
Patient Consultation
As an aid to patient consultation, refer to Advice for the Patient, Neomycin (Topical).
In providing consultation, consider emphasizing the following selected information (» = major clinical significance):
Before using this medication
» Conditions affecting use, especially:
Sensitivity to aminoglycosides
Proper use of this medication
Not using on deep or puncture wounds, serious burns, or raw areas unless directed by physician
Not for ophthalmic use
Before applying, washing affected area with soap and water, and drying thoroughly
Proper administration technique for cream and ointment
After applying, covering treated area with gauze dressing if desired
» Compliance with full course of therapy
» Proper dosing
Missed dose: Applying as soon as possible; not applying if almost time for next dose
» Proper storage
Precautions while using this medication
Checking with physician or pharmacist if no improvement within 1 week
Side/adverse effects
Signs of potential side effects, especially contact dermatitis and auditory ototoxicity
General Dosing Information
Use of topical antibacterials may lead to skin sensitization, resulting in hypersensitivity reactions with subsequent topical or systemic use of the medication.
The treated area(s) may be covered with a gauze dressing if desired.
Nephrotoxicity and moderate to severe ototoxicity may occur, especially if renal function is impaired and systemic nephrotoxic and/or ototoxic drugs are given concurrently. {11}
Topical Dosage Forms
NEOMYCIN SULFATE CREAM USP
Usual adult and adolescent dose
Antibacterial
Topical, to the skin, one to three times a day. {12}
Note: May be applied up to five times daily. {05}
Usual pediatric dose
See Usual adult and adolescent dose.
Strength(s) usually available
U.S.—
{04}
0.5% (OTC) [Myciguent]
Note: Each gram of cream contains 5 mg of neomycin sulfate, equivalent to 3.5 mg of neomycin base. {05}
Canada—
Not commercially available.
Packaging and storage:
Store preferably between 15 and 30 °C (59 and 86 °F), unless otherwise specified by manufacturer. Store in a well-closed container. Protect from freezing.
Auxiliary labeling:
• For external use only.
• Continue medication for full time of treatment.
NEOMYCIN SULFATE OINTMENT USP
Usual adult and adolescent dose
See Neomycin Sulfate Cream USP.
Note: May be applied up to five times daily. {02} {05}
Usual pediatric dose
See Neomycin Sulfate Cream USP.
Strength(s) usually available
U.S.—
0.5% (OTC) [Myciguent][Generic]{04}{06}
Canada—
Not commercially available.
Note: Each gram of ointment contains 5 mg of neomycin sulfate, equivalent to 3.5 mg of neomycin base. {05}
Packaging and storage:
Store preferably between 15 and 30 °C (59 and 86 °F), unless otherwise specified by manufacturer. Store in a well-closed container. Protect from freezing.
Auxiliary labeling:
• For external use only.
• Continue medication for full time of treatment.
Revised: 08/04/2000
References
- Indications Index review, 1986.
- Mycifradin package insert (Upjohn—US), Rev 11/85.
- USP DI 1989, VA Medication Classification System, 2472.
- Myciguent (Upjohn). In: Red book 1989. Oradell, NJ: Medical Economics Company, l989: 490.
- Myciguent (Upjohn). In: Krogh CME, editor. CPS Compendium of pharmaceuticals and specialties. 23rd ed. Ottawa: Canadian Pharmaceutical Association, 1988: 580.
- Neomycin. In: Red book 1989. Oradell, NJ: Medical Economics Company, 1989: 502-3.
- Heller, WM, editor. USAN 1990. USAN and the USP dictionary of drug names. Rockville, MD: The United States Pharmacopeial Convention, Inc., 1989: 379
- Hold
- Neomycin tablets package insert (Lilly—US), Rev 4/88, Rec 1/89.
- Hold
- McEvoy GK, editor. AHFS Drug information 89. Bethesda, MD: American Society of Hospital Pharmacists, 1989: 1925-7.
- Myciguent cream box label (Roberts—US), Rev 1992, Rec 4/94.
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