Neomycin Sulphate

Neomycin Sulphate is a aminoglycoside antibiotic medicine available in Bangladesh under many brand names. Below are its uses, dosage, side effects and precautions — and all brands with their current prices.

• Topical treatment of superficial bacterial skin infections caused by susceptible organisms.
• Topical treatment of susceptible bacterial eye infections when an ophthalmic preparation is prescribed.
• Topical treatment of susceptible external ear infections when an otic preparation is prescribed and the eardrum is intact.
• Oral use for intestinal decontamination before certain bowel surgery, when specifically prescribed.
• Oral use as an alternative or adjunct in selected cases of hepatic encephalopathy, only under specialist medical supervision.

Dosage depends on the dosage form, site of infection, age, kidney function and the reason for use. Eye drops, ear drops and ointments are usually applied locally for a short course exactly as directed on the prescription. Oral powder or sachet forms require careful medical supervision because absorption and toxicity risks can occur, especially with prolonged use or bowel disease. Do not change the dose, frequency or duration without consulting the prescribing doctor.

• Local burning, stinging, redness, itching or irritation at the application site.
• Allergic contact dermatitis or rash; sensitivity may be more likely with repeated topical use.
• Eye preparations may cause temporary blurred vision or eye irritation.
• Ear preparations may cause irritation; serious hearing or balance problems can occur if used with a perforated eardrum or absorbed systemically.
• Oral or excessive topical absorption may cause nausea, diarrhoea, kidney injury, hearing loss, ringing in the ears, dizziness or balance problems.
• Rarely, neuromuscular blockade with muscle weakness or breathing difficulty may occur, especially in vulnerable patients or with interacting medicines.

Use Neomycin Sulphate carefully in people with kidney disease, hearing or balance problems, myasthenia gravis or Parkinsonism, elderly patients, infants, dehydration, damaged or extensive skin wounds, and anyone using other medicines that may affect the kidneys or hearing. Ear preparations should not be used if the eardrum is perforated unless a doctor specifically advises it. Avoid prolonged or repeated use unless prescribed, as this may increase allergy, resistant infection and toxicity risks. Use this medicine under a registered doctor's or pharmacist's guidance.

• Other aminoglycoside antibiotics or medicines that can damage the kidneys or hearing may increase toxicity risk.
• Loop diuretics such as furosemide or ethacrynic acid may increase the risk of hearing damage.
• Cisplatin, vancomycin, amphotericin B, ciclosporin or tacrolimus may increase kidney toxicity risk.
• Neuromuscular blocking agents, some anaesthetics or large doses of magnesium may increase the risk of muscle weakness or breathing difficulty.
• Oral neomycin may reduce absorption of some medicines such as digoxin and may alter the effect of anticoagulants such as warfarin; monitoring may be needed.

• Known hypersensitivity to neomycin or other aminoglycoside antibiotics.
• Use in the ear when the eardrum is perforated, unless specifically directed by an ear specialist.
• Oral use in intestinal obstruction.
• Oral use in severe inflammatory or ulcerative gastrointestinal disease, where absorption and toxicity risk may be increased, unless a specialist determines it is necessary.
• Application to large areas of severely damaged skin when systemic absorption could be significant, unless specifically supervised by a doctor.

During pregnancy, Neomycin Sulphate should be used only if clearly needed and prescribed, because systemic aminoglycoside exposure may pose a risk to the fetus, including potential hearing-related toxicity. Topical use on small areas generally results in lower absorption, but prolonged use, large-area use, damaged skin or oral use needs medical advice. During breastfeeding, use only as advised by a doctor; avoid applying it to the nipple or areas where the infant may ingest it, and monitor the baby for diarrhoea, rash or thrush if maternal oral use is required.

Store at room temperature, away from excessive heat, moisture and direct sunlight. Keep the container tightly closed and out of reach of children. Do not touch the dropper or tube tip to any surface, eye, ear or skin. Do not use after the expiry date, and discard opened eye or ear drops within the period recommended on the label or by the pharmacist.