Skip to Content

Neomycin (Topical)

Class: Antibacterials
VA Class: DE101
CAS Number: 1405-10-3

Medically reviewed by Drugs.com. Last updated on July 13, 2020.

Introduction

Aminoglycoside antibiotic.141 144

Uses for Neomycin (Topical)

Superficial Bacterial Skin Infections

Used topically in fixed combination with other anti-infectives (i.e., polymyxin B with or without bacitracin) for prevention of superficial bacterial skin infections associated with minor cuts, scrapes, or burns.107 108 109 111 112 116 141

Has been used in fixed combination with other anti-infectives for topical treatment of minor skin infections caused by susceptible bacteria.116 141 144 Role, if any, of topical anti-infectives for treatment of superficial skin infections not fully elucidated.a

Self-medication with topical anti-infectives for prevention or treatment of superficial skin infections not usually recommended.116 a

Infected Corticosteroid-responsive Dermatoses

Used topically in fixed combination with a corticosteroid (i.e., fluocinolone, hydrocortisone) with or without other anti-infectives (i.e., polymyxin B with or without bacitracin) for treatment of corticosteroid-responsive dermatoses with secondary infection.110 113 114

No evidence that fixed-combination topical preparations that include anti-infectives and a corticosteroid provide greater benefit than use of a topical corticosteroid alone after 7 days of treatment.110 113 114 Weigh possible benefits of fixed-combination topical preparation containing anti-infectives and a corticosteroid against risk that the corticosteroid may mask clinical signs of bacterial, fungal, or viral infections; prevent recognition of ineffectiveness of the anti-infective; or suppress hypersensitivity reactions to ingredients in the formulation.a

Prevention of Bacteriuria Associated with Indwelling Catheters

Fixed combination of neomycin and polymyxin B used for short-term (≤10 days) continuous irrigation of the urinary bladder in abacteriuric patients for prevention of bacteriuria and gram-negative septicemia associated with use of indwelling catheters.100 144

Routine bladder irrigation with anti-infectives not recommended to prevent or eradicate catheter-associated bacteriuria in patients with indwelling catheters;120 use of neomycin solutions for bladder irrigation no longer recommended.144

Instillation/Irrigation

Has been used in the past for peritoneal instillation and for irrigation of wounds or surgical sites; no longer recommended for these uses because severe toxicity (e.g., ototoxicity) may occur.a

Neomycin (Topical) Dosage and Administration

Administration

Topical Administration

Apply topically to skin as an ointment or cream.107 108 109 110 111 112 114

For external use only on skin;107 108 109 110 111 112 113 114 do not use in the eyes.107 108 109 110 111 112 113 114

Do not apply to extensive areas of skin, deep or puncture wounds, animal bites, or serious burns.107 108 109 111 112

Apply small amount of topical ointment or cream (amount equal to surface area of fingertip) to cleansed, affected areas of skin.107 108 109 110 111 112 113 114

May cover affected areas with a sterile bandage.107 108 109 111 112 However, at least one manufacturer of a topical preparation containing neomycin and a corticosteroid (i.e., fluocinolone) states do not use bandages or occlusive coverings on treated areas of skin unless directed by a clinician.113

Bladder Irrigation

Commercially available irrigation solution concentrate containing fixed combination of neomycin and polymyxin B is for continuous irrigation of the intact urinary bladder only;100 do not use for irrigation at any other site and do not administer by injection or any other route.100

The irrigation solution concentrate must be diluted prior to use.100

Administer diluted irrigation solution by continuous bladder irrigation via a 3-way catheter;100 do not interrupt inflow of the diluted solution for more than a few minutes.100

Dilution

Add contents of 1-mL ampul of commercially available irrigation solution concentrate (40 mg of neomycin and 200,000 units of polymyxin B sulfate) to 1 L of 0.9% sodium chloride solution.100

Rate of Administration

Administer diluted irrigation solution by continuous bladder irrigation using inflow rate of 1 L every 24 hours.100 Adjust inflow rate to 2 L every 24 hours if patient’s urine output exceeds 2 L daily.100

Dosage

Available as neomycin sulfate; dosage usually expressed in terms of the base.100 107 109 110 111 112 113 114

Pediatric Patients

Prevention of Superficial Bacterial Skin Infections
Topical

Children ≥2 years of age: Apply ointment or cream to affected areas of skin 1–3 times daily.108 111

May use for up to 1 week for self-medication.108 111 112 Discontinue use and contact a clinician if condition persists for >1 week or worsens.108 111 112

Adults

Prevention of Superficial Bacterial Skin Infections
Topical

Ointment or cream: Apply to affected areas of skin 1–3 times daily.107 108 109 111 112

May use for up to 1 week for self-medication.107 108 109 111 112 Discontinue use and contact a clinician if condition persists for >1 week or worsens.107 108 109 111 112

Infected Corticosteroid-responsive Dermatoses
Topical

Ointment or cream (fixed combination of neomycin and a corticosteroid with or without other anti-infectives): Apply thin film to affected areas of skin 2–4 times daily for up to 7 days.110 113 114

Prevention of Bacteriuria Associated with Indwelling Catheters
Bladder Irrigation

1 L of diluted irrigation solution (40 mg of neomycin and 200,000 units of polymyxin B sulfate in 0.9% sodium chloride solution) by continuous bladder irrigation every 24 hours for up to 10 days.100 (See Bladder Irrigation under Dosage and Administration.)

Prescribing Limits

Pediatric Patients

Prevention of Superficial Bacterial Skin Infections
Topical

Maximum duration: 1 week, unless directed by a clinician.107 108 109 111 112

Adults

Prevention of Superficial Bacterial Skin Infections
Topical

Maximum duration: 1 week, unless directed by a clinician.107 108 109 111 112

Infected Corticosteroid-responsive Dermatoses
Topical

Maximum duration: 7 days.110

Prevention of Bacteriuria Associated with Indwelling Catheters
Bladder Irrigation

Maximum duration: 10 days.100

Cautions for Neomycin (Topical)

Contraindications

  • Topical (fixed combinations of neomycin and other anti-infectives with or without a topical anesthetic): Hypersensitivity to neomycin or any ingredient in the formulation.107 108 109 111 112

  • Topical (fixed combinations of neomycin and a corticosteroid with or without other anti-infectives): Hypersensitivity to any ingredient in the formulation110 113 114 or presence of tuberculous, fungal, or viral (e.g., herpes simplex, varicella zoster) skin lesions.110 114 Also contraindicated for use in the eyes or in external ear canal if eardrum is perforated.110 113 114

  • Bladder irrigation (fixed combination of neomycin and polymyxin B): Hypersensitivity to neomycin, polymyxins, or any ingredient in the formulation.100 Because of cross-sensitivity among aminoglycosides, may also be contraindicated in those with history of hypersensitivity or serious toxic reaction to any aminoglycoside.100

Warnings/Precautions

Sensitivity Reactions

Hypersensitivity reactions, including contact dermatitis, burning, erythema, rash, and urticaria, reported following topical application of neomycin in patients sensitive to the drug or other ingredients in the formulation.a Anaphylactoid reactions reported rarely with topical application of neomycin.a

Topical neomycin is a contact sensitizer, especially when used for prolonged periods.a

Consider that patients allergic to neomycin may have cutaneous sensitivity reactions or anaphylactic reactions to the drug.110 141

If itching, burning, rash, or any other signs of sensitivity or allergic reaction occur, discontinue use and consult a clinician.107 108 109 110 111 112 113

Cross-allergenicity occurs among the aminoglycosides; consider that patients sensitive to topical neomycin may also be sensitive to other topical and/or systemic aminoglycosides.110

Patients allergic to one fixed-combination topical preparation containing neomycin should avoid preparations containing any of the component drugs.a

Other Warnings and Precautions

Precautions Related to Topical Use

Do not use for >1 week unless directed by a clinician.107 108 109 111 112

Prolonged use may promote bacterial resistance and should be avoided.110 141 144 Overgrowth of nonsusceptible organisms, including fungi, may occur.110

Ototoxicity, nephrotoxicity, and neuromuscular blockade reported following topical application of neomycin resulting in systemic absorption of the drug, especially when used for peritoneal instillation, irrigation of wounds or surgical sites, or topical treatment for skin ulcers, granulating wounds, serious burns, or extensive areas of denuded skin.a Death reported rarely.a

Because of risk of systemic absorption and possibility of toxicity (ototoxicity, nephrotoxicity, neuromuscular blockade), use with caution for topical treatment of extensive burns, trophic ulceration, or other extensive dermatologic conditions where rapid absorption of the drug is possible.a Apply topical neomycin no more than once daily in treatment of patients with burns covering ≥20% of their body surface area, especially if patient has impaired renal function or is receiving other aminoglycosides concurrently.a

Precautions Related to Bladder Irrigation

Do not use irrigation solution containing fixed combination of neomycin and polymyxin B if there is a possibility of systemic absorption.100 The irrigation solution is intended for continuous prophylactic bladder irrigation only in patients with an intact urinary bladder.100 Because of risk of systemic absorption and toxicity (e.g., ototoxicity, nephrotoxicity, neuromuscular blockade), avoid use in patients with defects in bladder mucosa or bladder wall (e.g., vesical rupture) and do not use in conjunction with operative procedures involving bladder wall.100 Patients with impaired renal function, infants, dehydrated patients, geriatric patients, and those receiving prolonged treatment with high doses are especially at risk for toxicity.100

Safety and efficacy of bladder irrigation with the fixed combination solution not established in patients with recent lower urinary tract surgery.100

Bladder irrigation may result in overgrowth of nonsusceptible organisms, including fungi; take appropriate measures as needed.100

Collect urine specimens for urinalysis, culture, and susceptibility testing.100 If uropathogens isolated, perform in vitro susceptibility testing and initiate systemic anti-infective therapy if appropriate.100

Use of Fixed Combinations

When used in fixed combination with other topical anti-infectives (i.e., polymyxin B with or without bacitracin), topical corticosteroids (i.e., fluocinolone, hydrocortisone), or topical anesthetics (i.e., lidocaine, pramoxine), consider cautions, precautions, and contraindications associated with each drug in the fixed combination.a

When fixed combination containing a corticosteroid (i.e., fluocinolone, hydrocortisone) used, consider that topical corticosteroids used in fixed combination with topical anti-infectives may mask clinical signs of bacterial, fungal, or viral infections, or may suppress hypersensitivity reactions to the anti-infectives or other ingredients in the formulation.144 Also consider that use of topical corticosteroids can result in signs and symptoms of exogenous hyperadrenocorticism, including adrenal suppression, and that systemic absorption of topically applied corticosteroids is increased if extensive body surface areas treated or if occlusive dressing used.110 113 114 Discontinue use if redness, irritation, swelling, or pain persists or increases.110 113 114

Specific Populations

Pregnancy

Aminoglycosides may cause fetal harm following systemic absorption in pregnant women.100 The drugs cross the placenta;100 total, irreversible, bilateral, congenital deafness reported in some children whose mothers received parenteral streptomycin during pregnancy.100

Topical (neomycin in fixed combination with other anti-infectives): Category C.140

Topical (fixed combination of neomycin and a corticosteroid with or without other anti-infectives): Use during pregnancy only if potential benefits justify potential risks to fetus.110 113 114 Topical corticosteroids have been teratogenic in animals (mice, rabbits).110 113 114

Bladder irrigation (fixed combination of neomycin and polymyxin B): If used during pregnancy, inform patient about potential hazard to the fetus.100

Lactation

Clinically unimportant amounts of neomycin may distribute into breast milk following systemic absorption.140

Topical (fixed combination of neomycin and a corticosteroid with or without other anti-infectives): Use with caution in nursing women.110 113 114 Systemic corticosteroids (e.g., oral) are distributed into human milk;110 113 114 systemic absorption may occur when corticosteroids are applied topically.110 114

Pediatric Use

Topical: Some manufacturers state do not use in children ≤2 years of age unless directed by a clinician.108 111

Topical (fixed combination of neomycin and fluocinolone): Manufacturer states use least amount compatible with an effective therapy regimen;113 pediatric patients may be more susceptible to topical corticosteroid-induced hypothalamic-pituitary-adrenal (HPA) axis suppression and Cushing's syndrome than more mature patients because of a larger skin surface area to body weight ratio.113

Topical (fixed combination of neomycin, polymyxin B with or without bacitracin, and hydrocortisone): Safety and efficacy not established in pediatric patients.110 114 If topical hydrocortisone used for prolonged periods in infants and children, sufficient percutaneous absorption of the drug can occur and cause cessation of growth, as well as other signs and symptoms of hyperadrenocorticism.110

Topical (fixed combination of neomycin, polymyxin B, bacitracin, and lidocaine): At least one manufacturer states do not use in children <12 years of age unless directed by a clinician.112

Bladder irrigation (fixed combination of neomycin and polymyxin B): Safety and efficacy not established in pediatric patients.100

Geriatric Use

Topical (fixed combination of neomycin, polymyxin B with or without bacitracin, and hydrocortisone): Clinical studies did not include sufficient numbers of patients ≥65 years of age to determine whether geriatric individuals respond differently than younger patients; other reported clinical experience has not identified differences in responses between geriatric and younger patients.110 114

Bladder irrigation (fixed combination of neomycin and polymyxin B): Increased risk of toxicity in geriatric patients receiving prolonged treatment with high doses.100

Renal Impairment

Bladder irrigation (fixed combination of neomycin and polymyxin B): Risk of toxicity increased in patients with renal impairment.100

Common Adverse Effects

Topical: Allergic contact dermatitis.a

Bladder irrigation: Irritation of urinary bladder mucosa.100

Neomycin (Topical) Pharmacokinetics

Absorption

Bioavailability

Topical: Not absorbed to any appreciable extent from intact skin.141 Readily absorbed through denuded or abraded areas of skin or skin that has lost the keratin layer (i.e., wounds, burns, ulcers).a

Bladder irrigation: Systemic absorption not expected to be clinically important if bladder is intact and duration of irrigation is ≤10 days.100 Systemic absorption may occur if bladder surface is denuded or inflamed.100 144

Rapidly absorbed from the peritoneum, draining sinuses, wounds, or surgical sites.a

Plasma Concentrations

Plasma concentrations following topical application to open wounds, burns, or granulating surfaces comparable to, or higher than, those achieved following oral or parenteral administration (parenteral preparation no longer available in US).100

Stability

Storage

Topical

Ointments and Creams

20–25107 108 or 15–30°C,109 110 111 112 113 114 depending on manufacturer.

Some manufacturers state protect from excessive heat111 112 113 and freezing.111 113

Bladder Irrigation

Solution Concentrate for Irrigation

2–8°C.100

Following dilution in 0.9% sodium chloride, store at 4°C and use within 48 hours after dilution.100

Actions and Spectrum

  • Usually bactericidal.a

  • Appears to inhibit protein synthesis in susceptible bacteria by irreversibly binding to 30S ribosomal subunits.a

  • Spectrum of activity includes some aerobic gram-positive bacteria and many aerobic gram-negative bacteria.141 144 a

  • Gram-positive aerobes: Active against Staphylococcus aureus and S. epidermidis.a Most streptococci are resistant.a

  • Gram-negative aerobes: Active against Escherichia coli, Haemophilus influenzae, Klebsiella, Neisseria, Moraxella lacinate, and Proteus.a Inactive against Serratia and Pseudomonas aeruginosa.a

Advice to Patients

  • Inform patients that topical preparations containing neomycin are for external use only; do not use in the eyes and do not apply over large areas of the body.107 108 109 110 111 112 113

  • For self-medication, importance of not using topical preparations containing neomycin for >1 week for prevention of infection in minor skin injuries (e.g., cuts, scrapes, burns) unless directed by a clinician;107 108 109 111 112 importance of discontinuing use and consulting clinician if condition persists or worsens.107 108 109 111 112

  • Importance of discontinuing topical preparation containing neomycin and consulting a clinician if itching, burning, rash or any other signs of sensitivity or allergic reaction occur.107 108 109 110 111 112 113

  • Importance of first consulting a clinician if considering use for self-medication for deep or puncture wounds, animal bites, or serious burns.107 108 109 111 112

  • Importance of women informing clinicians if they are or plan to become pregnant or plan to breast-feed.100 110 113 114

  • Importance of informing patients of other important precautionary information.a (See Cautions.)

Preparations

Excipients in commercially available drug preparations may have clinically important effects in some individuals; consult specific product labeling for details.

Please refer to the ASHP Drug Shortages Resource Center for information on shortages of one or more of these preparations.

* available from one or more manufacturer, distributor, and/or repackager by generic (nonproprietary) name

Neomycin and Polymyxin B Sulfates

Routes

Dosage Forms

Strengths

Brand Names

Manufacturer

Urogenital

For irrigation, concentrate

Neosporin Sulfate 40 mg (of neomycin) per mL and Polymyxin B Sulfate 200,000 units per mL*

Neomycin and Polymyxin B Sulfates Solution for Irrigation

Neosporin G.U. Irrigant

Pfizer

* available from one or more manufacturer, distributor, and/or repackager by generic (nonproprietary) name

Neomycin and Polymyxin B Sulfates and Bacitracin Zinc

Routes

Dosage Forms

Strengths

Brand Names

Manufacturer

Topical

Ointment

Neomycin Sulfate 3.5 mg (of neomycin) per g, Polymyxin B Sulfate 5000 units (of polymyxin B) per g, and Bacitracin Zinc 400 units (of bacitracin) per g*

Neomycin and Polymyxin B Sulfates and Bacitracin Zinc Ointment

Neosporin Original

Johnson & Johnson

Triple Antibiotic Ointment

Neomycin and Polymyxin B Sulfates, Bacitracin Zinc, and Hydrocortisone

Routes

Dosage Forms

Strengths

Brand Names

Manufacturer

Topical

Ointment

Neomycin Sulfate 3.5 mg (of neomycin) per g, Polymyxin B Sulfate 5000 units (of polymyxin B) per g, Bacitracin Zinc 400 units (of bacitracin) per g, and Hydrocortisone 1%

Cortisporin Ointment

Pfizer

Neomycin and Polymyxin B Sulfates and Hydrocortisone Acetate

Routes

Dosage Forms

Strengths

Brand Names

Manufacturer

Topical

Cream

Neomycin Sulfate 3.5 mg (of neomycin) per g, Polymyxin B Sulfate 10,000 units (of polymyxin B) per g, and Hydrocortisone Acetate 5 mg per g

Cortisporin Cream

Pfizer

Neomycin Sulfate and Fluocinolone Acetonide

Routes

Dosage Forms

Strengths

Brand Names

Manufacturer

Topical

Cream

Neomycin Sulfate 3.5 mg (of neomycin) per g and Fluocinolone Acetonide 0.25 mg per g

Neo-Synalar

Medimetriks

* available from one or more manufacturer, distributor, and/or repackager by generic (nonproprietary) name

Other Neomycin Sulfate Combinations

Routes

Dosage Forms

Strengths

Brand Names

Manufacturer

Topical

Cream

Neomycin Sulfate 3.5 mg (of neomycin) per g, Polymyxin B Sulfate 5000 units (of polymyxin B) per g, Bacitracin Zinc 400 units (of bacitracin) per g, and Lidocaine Hydrochloride 20 mg per g*

Neomycin and Polymyxin B Sulfates, Bacitracin Zinc, and Lidocaine Hydrochloride Cream

Neomycin Sulfate 3.5 mg (of neomycin) per g, Polymyxin B Sulfate 10,000 units (of polymyxin B) per g, and Pramoxine Hydrochloride 10 mg per g*

Neomycin Sulfate, Polymyxin B Sulfate, and Pramoxine Hydrochloride Cream

Ointment

Neomycin Sulfate 3.5 mg (of neomycin) per g, Polymyxin B Sulfate 5000 units per g, Bacitracin Zinc 400 units per g, and Lidocaine 40 mg per g*

Neomycin and Polymyxin B Sulfates, Bacitracin Zinc, and Lidocaine Ointment

Neomycin Sulfate 3.5 mg (of neomycin) per g, Polymyxin B Sulfate 10,000 units (of polymyxin B) per g, Bacitracin Zinc 500 units (of bacitracin) per g, and Pramoxine Hydrochloride 10 mg per g*

Neomycin Sulfate, Polymyxin B Sulfate, Bacitracin Zinc, and Pramoxine Hydrochloride Ointment

Triple Antibiotic Plus

Neosporin Plus

Johnson & Johnson

AHFS DI Essentials™. © Copyright 2021, Selected Revisions July 13, 2020. American Society of Health-System Pharmacists, Inc., 4500 East-West Highway, Suite 900, Bethesda, Maryland 20814.

† Use is not currently included in the labeling approved by the US Food and Drug Administration.

References

100. Pfizer. Neosporin G.U. Irrigant Sterile (neomycin sulfate-polymyxin B sulfate solution for irrigation) prescribing information. New York, NY; 2016 Sep.

107. Johnson & Johnson. Neosporin Original (bacitracin zinc, neomycin sulfate, and polymyxin B sulfate) ointment patient information. Skillman, NJ; Undated. From Dailymed website. Accessed 2020 Jan 15.

108. Johnson & Johnson. Neosporin Plus (bacitracin zinc, neomycin sulfate, polymyxin B sulfate, and pramoxine hydrochloride) ointment patient information. Skillman, NJ; Undated. From Dailymed website. Accessed 2020 Jan 15.

109. Actavis Pharma. Triple Antibiotic (bacitracin zinc, neomycin sulfate, and polymyxin B sulfate) ointment patient information. Parsippany, NJ; Undated. From Dailymed website. Accessed 2020 Jan 15.

110. Pfizer Laboratories. Cortisporin (neomycin and polymyxin B sulfates, bacitracin zinc, and hydrocortisone) ointment prescribing information. New York, NY; 2016 Aug.

111. CellNovation Technology. Bacitracin zinc, neomycin sulfate, polymyxin B sulfate, and lidocaine hydrochloride cream patient information. Undated. From Dailymed website. Accessed 2020 Jan 15.

112. Hart Health. Tribioticlc LC (bacitracin zinc, neomycin sulfate, polymyxin B sulfate, and lidocaine) ointment patient information. Seattle, WA; Undated. From Dailymed website. Accessed 2020 Jan 15.

113. Medimetriks Pharmaceuticals. Neo-Synalar (neomycin sulfate and fluocinolone acetonide) cream prescribing information. Fairfield, NJ; 2016 Sep.

114. Pfizer Laboratories. Cortisporin (neomycin sulfate, polymyxin B sulfate, and hydrocortisone acetate) cream prescribing information. New York, NY; 2016 Aug.

116. Williamson DA, Carter GP, Howden BP. Current and Emerging Topical Antibacterials and Antiseptics: Agents, Action, and Resistance Patterns. Clin Microbiol Rev. 2017; 30:827-860. http://www.ncbi.nlm.nih.gov/pubmed/28592405?dopt=AbstractPlus

120. Hooton TM, Bradley SF, Cardenas DD et al. Diagnosis, prevention, and treatment of catheter-associated urinary tract infection in adults: 2009 International Clinical Practice Guidelines from the Infectious Diseases Society of America. Clin Infect Dis. 2010; 50:625-63. Updates may be available at IDSA website at www.idsociety.org. http://www.ncbi.nlm.nih.gov/pubmed/20175247?dopt=AbstractPlus

140. Briggs GG, Freeman RK, Yaffe SJ. Drugs in pregnancy and lactation. 6th ed. Philadelphia: Lippincott Williams & Wilkins; 2002: 983/n-4/n.

141. O'Donnell JA, Gelone SP, and Safdar M. Topical antibacterials. In: Bennett JE, Dolin R, and Blaser MJ, eds. Mandell, Douglas, and Bennett's principles and practices of infectious diseases. 8th ed. Philadelphia, PA: Elsevier Saunders; 2015:1844-80.

144. Mouton JW. Neomycin. In: Grayson ML, ed. Kucers' the use of antibiotics: a clinical review of antibacterial, antifungal, antiparasitic, and antiviral drugs. 7th ed. Boca Raton, FL: CRC Press; 2018: 1046-52.

a. AHFS drug information 2020. Snow EK, ed. Neomycin Sulfate. Bethesda, MD: American Society of Health-System Pharmacists; 2020.