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Bacitracin, Neomycin, and Polymyxin B (Ophthalmic)

Pronunciation

(bas i TRAY sin, nee oh MYE sin, & pol i MIKS in bee)

Index Terms

  • Neomycin, Bacitracin, and Polymyxin B
  • Polymyxin B, Bacitracin, and Neomycin

Dosage Forms

Excipient information presented when available (limited, particularly for generics); consult specific product labeling.

Ointment, Ophthalmic:

Neo-Polycin: Bacitracin 400 units, neomycin 3.5 mg, and polymyxin B 10,000 units per g (3.5 g)

Generic: Bacitracin 400 units, neomycin 3.5 mg, and polymyxin B 10,000 units per g (3.5 g)

Brand Names: U.S.

  • Neo-Polycin

Pharmacologic Category

  • Antibiotic, Ophthalmic

Pharmacology

Bacitracin: Inhibits bacterial cell wall synthesis by preventing transfer of mucopeptides into the growing cell wall.

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

Polymyxin B: Binds to phospholipids, alters permeability, and damages the bacterial cytoplasmic membrane permitting leakage of intracellular constituents.

Use: Labeled Indications

Ocular infections: Treatment of superficial external ocular infections (eg, conjunctivitis, keratitis, keratoconjunctivitis, blepharitis, blepharoconjunctivitis) caused by susceptible organisms.

Contraindications

Hypersensitivity to neomycin, polymyxin B, bacitracin, or any component of the formulation

Dosing: Adult

Ocular infections: Ophthalmic: Apply every 3 to 4 hours for 7 to 10 days.

Dosing: Geriatric

Refer to adult dosing.

Dosing: Pediatric

Conjunctivitis (off-label): Limited data available: Children and Adolescents: Ophthalmic: Ointment: Apply 0.5 inch ribbon every 3 to 4 hours for acute infections, or 2 to 3 times per day for mild to moderate infections, for 7 to 10 days (Pichichero 2011).

Dosing: Renal Impairment

There are no dosage adjustments provided in the manufacturer’s labeling.

Dosing: Hepatic Impairment

There are no dosage adjustments provided in the manufacturer’s labeling.

Administration

For ophthalmic use only; not for injection into the eye. Avoid contamination of the tip of the ointment tube.

Storage

Store at room temperature.

Drug Interactions

There are no known significant interactions.

Adverse Reactions

Frequency not defined.

Dermatologic: Reddening, allergic contact dermatitis

Local: Itching, failure to heal, swelling, irritation

Ophthalmic: Conjunctival edema

Miscellaneous: Anaphylaxis

Warnings/Precautions

Concerns related to adverse effects:

• Neomycin sensitization: Neomycin may cause cutaneous sensitization. Symptoms of neomycin sensitization include itching, reddening, edema, and failure to heal. Discontinuation of product and avoidance of similar products should be considered.

• Ocular effects: May retard corneal wound healing.

• Superinfection: Prolonged use may lead to overgrowth of nonsusceptible organisms, including fungi. If superinfection is suspected, institute appropriate alternative therapy.

Other warnings/precautions:

• Appropriate use: For topical ophthalmic use only. Do not introduce directly into anterior chamber of the eye. Inadvertent contamination of multiple-dose ophthalmic tube tip has caused bacterial keratitis.

Pregnancy Risk Factor

C

Pregnancy Considerations

Animal reproduction studies have not been conducted with this combination.

Patient Education

• Discuss specific use of drug and side effects with patient as it relates to treatment. (HCAHPS: During this hospital stay, were you given any medicine that you had not taken before? Before giving you any new medicine, how often did hospital staff tell you what the medicine was for? How often did hospital staff describe possible side effects in a way you could understand?)

• Have patient report immediately to prescriber vision changes, eye pain, severe eye irritation, or eye discharge (HCAHPS).

• Educate patient about signs of a significant reaction (eg, wheezing; chest tightness; fever; itching; bad cough; blue skin color; seizures; or swelling of face, lips, tongue, or throat). Note: This is not a comprehensive list of all side effects. Patient should consult prescriber for additional questions.

Intended Use and Disclaimer: Should not be printed and given to patients. This information is intended to serve as a concise initial reference for health care professionals to use when discussing medications with a patient. You must ultimately rely on your own discretion, experience, and judgment in diagnosing, treating, and advising patients.

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