Pill Identifier App

Neomycin, Polymyxin B, and Bacitracin (Ophthalmic)


VA CLASSIFICATION
Primary: OP201

Commonly used brand name(s): Ak-Spore Ophthalmic Ointment; Neocidin Ophthalmic Ointment; Neosporin Ophthalmic Ointment; Neotal; Ocu-Spor-B; Ocusporin; Ocutricin Ophthalmic Ointment; Ophthalmic; Spectro-Sporin; Triple Antibiotic.

Note: For a listing of dosage forms and brand names by country availability, see Dosage Forms section(s).



Category:


Antibacterial (ophthalmic)—

Indications

Note: Bracketed information in the Indications section refers to uses that are not included in U.S. product labeling.

Accepted

Ocular infections (treatment)—Ophthalmic neomycin, polymyxin B, and bacitracin combination is indicated in the short-term {05} {06} treatment of superficial external ocular infections caused by susceptible organisms. {05} {06}

[Blepharitis, bacterial (treatment)]{01}
[Blepharoconjunctivitis (treatment)]{01}
[Conjunctivitis, bacterial (treatment)]{01}
[Keratitis, bacterial (treatment)]or{01}
[Keratoconjunctivitis, bacterial (treatment)]—Ophthalmic neomycin, polymyxin B, and bacitracin combination is used in the treatment of bacterial blepharitis, blepharoconjunctivitis, bacterial conjunctivitis, bacterial keratitis, and bacterial keratoconjunctivitis. {01}

Note: Long-term treatment with this medication is rarely indicated.
Not all species or strains of a particular organism may be susceptible to neomycin, polymyxin B, and bacitracin combination.



Pharmacology/Pharmacokinetics

Physicochemical characteristics:
Source—
    Neomycin: Derived from Streptomyces fradiae . {02}
    Polymyxin B: Derived from polymyxin B 1 and polymyxin B 2, which are produced by the growth of Bacillus polymyxa . {03}
    Bacitracin: Derived from a mixture of related antibiotics (mainly bacitracin A), which are produced by the growth of Bacillus subtilis ssp. licheniformis . {03}

Chemical group—
    Neomycin: Aminoglycosides.
    Polymyxin B: Polypeptides.
    Bacitracin: Cyclic polypeptides. {03}

Mechanism of action/Effect:

Neomycin—See Neomycin (Ophthalmic).

Polymyxin B is bactericidal and active against Pseudomonas aeruginosa and other gram-negative bacteria. It is a surface-active basic polypeptide that binds to anionic phospholipid sites in bacterial cytoplasmic membranes, disrupts membrane structure, and alters membrane permeability to allow leakage of intracellular contents. Its action is antagonized by calcium and magnesium.

Bacitracin, a polypeptide antibiotic, is usually bactericidal against gram-positive organisms. It acts within the bacterial cell membrane and interferes with bacterial cell wall synthesis by binding to and inhibiting the dephosphorylation of a membrane-bound lipid pyrophosphate. Pyrophosphate is the precursor of a carrier molecule, undecaprenyl phosphate, which is involved in peptidoglycan polymerization.

Absorption:

Neomycin and polymyxin B—May be absorbed following topical application to the eye if tissue damage is present.

Bacitracin—Not significantly absorbed.


Precautions to Consider

Cross-sensitivity and/or related problems

Patients sensitive to one aminoglycoside or polymyxin may be sensitive to other aminoglycosides or polymyxins also. {05} {06}

Pregnancy/Reproduction

Pregnancy—
Problems in humans have not been documented.

Breast-feeding

Problems in humans have not been documented.

Pediatrics

Appropriate studies on the relationship of age to the effects of neomycin, polymyxin B, and bacitracin combination have not been performed in the pediatric population. However, no pediatrics-specific problems have been documented to date.


Geriatrics


Appropriate studies on the relationship of age to the effects of neomycin, polymyxin B, and bacitracin combination have not been performed in the geriatric population. However, no geriatrics-specific problems have been documented to date.

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 neomycin, polymyxin B, or bacitracin{05}{06}


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
Incidence more frequent
    
Hypersensitivity (itching, rash, redness, swelling, or other sign of irritation not present before therapy)



Those not indicating need for medical attention
    
Blurred vision, from the ointment




Patient Consultation
As an aid to patient consultation, refer to Advice for the Patient, Neomycin, Polymyxin B, and Bacitracin (Ophthalmic).

In providing consultation, consider emphasizing the following selected information (» = major clinical significance):

Before using this medication
»   Conditions affecting use, especially:
Sensitivity to neomycin, polymyxin B, or bacitracin or to any related antibiotic, such as amikacin, colistimethate, colistin, gentamicin, kanamycin, netilmicin, paromomycin, streptomycin, or tobramycin

Proper use of this medication
Proper administration technique for ophthalmic ointment

» 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 if no improvement within a few days


Side/adverse effects
Blurred vision may occur for a few minutes after application of ophthalmic ointments

Signs of potential side effects, especially hypersensitivity


Ophthalmic Dosage Forms

NEOMYCIN AND POLYMYXIN B SULFATES AND BACITRACIN ZINC OPHTHALMIC OINTMENT USP

Usual adult and adolescent dose
Ophthalmic antibacterial—Topical, to the conjunctiva, a thin strip (approximately 1 cm) of ointment every three to four hours for seven to ten days. {04} {05} {06}

Usual pediatric dose
See Usual adult and adolescent dose.

Strength(s) usually available
U.S.—


3.5 mg of neomycin (base), 5,000 Units of polymyxin B (base), and 400 Units of bacitracin zinc per gram (Rx) [Neotal{11}] [Triple Antibiotic{15}]


3.5 mg of neomycin (base), 10,000 Units of polymyxin B (base), and 400 Units of bacitracin zinc per gram (Rx) [Ak-Spore Ophthalmic Ointment] [Neocidin Ophthalmic Ointment{10}] [Neosporin Ophthalmic Ointment] [Ocu-Spor-B{07}] [Ocusporin{12}] [Ocutricin Ophthalmic Ointment{08}] [Ophthalmic{13}] [Spectro-Sporin{09}][Generic]

Canada—


3.5 mg of neomycin (base), 10,000 Units of polymyxin B (base), and 400 Units of bacitracin zinc per gram (Rx) [Neosporin Ophthalmic Ointment{14}]

Packaging and storage:
Store below 40 °C (104 °F), preferably between 15 and 30 °C (59 and 86 °F), unless otherwise specified by manufacturer. Store in a collapsible ophthalmic ointment tube. Protect from freezing.

Auxiliary labeling:
   • For the eye.
   • Continue medicine for full time of treatment.



Revised: 05/24/1995



References
  1. Per Indications Index review, 1986.
  1. Mycifradin (Oral-Local) package insert (Upjohn—US), Rev 11/85.
  1. Neosporin ophthalmic ointment package insert (BW—US), Rev 11/83, Rec 3/22/85.
  1. Neosporin ophthalmic (BW). In: PDR Physicians' desk reference for ophthalmology. 16th ed. 1988. Oradell, NJ: Medical Economics Company, 1988: 113.
  1. Ak-Spore ophthalmic ointment (Akorn). In: PDR Physicians' desk reference for ophthalmology. 22nd ed. 1994. Montvale, NJ: Medical Economics Data Production Company, 1994: 204.
  1. Neosporin ophthalmic ointment (BW). In: PDR Physicians' desk reference for ophthalmology. 22nd ed. 1994. Montvale, NJ: Medical Economics Data Production Company, 1994: 268.
  1. Ocu-Spor-B (Ocumed). In: PDR Physicians' desk reference for ophthalmology. 22nd ed. 1994. Montvale, NJ: Medical Economics Data Production Company, 1994: 303.
  1. Ocutricin ophthalmic ointment (B&L). In: PDR Physicians' desk reference for ophthalmology. 22nd ed. 1994. Montvale, NJ: Medical Economics Data Production Company, 1994: 262.
  1. Spectro-Sporin (Spectrum). In: Red book 1993. Montvale, NJ: Medical Economics Data, 1993: 521.
  1. Neocidin ophthalmic ointment (Major). In: Red book 1993. Montvale, NJ: Medical Economics Data, 1993: 395.
  1. Neotal (Hauck). In: Red book 1993. Montvale, NJ: Medical Economics Data, 1993: 397.
  1. Ocusporin (Moore). In: Red book 1993. Montvale, NJ: Medical Economics Data, 1993: 413.
  1. Ophthalmic (Vortech). In: Red book 1993. Montvale, NJ: Medical Economics Data, 1993: 416.
  1. Neosporin ophthalmic ointment (BW). In: Krogh CME, editor. CPS Compendium of pharmaceuticals and specialties. 28th ed. Ottawa: Canadian Pharmaceutical Association, 1993: 793.
  1. Triple Antibiotic (Rugby). In: Olin BR, editor. Drug facts and comparisons. St. Louis: Facts and Comparisons Inc, 1993: 494.
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