Neomycin + Polymyxin B + Gramicidin

Ophthalmic
Superficial ocular infections

Polymyxin B: Inactivated by strong acids and alkalis.

Hypersensitivity to neomycin, polymyxin B or gramicidin, or to any of its component.

Patient with otitis media. Prolonged use may cause overgrowth of nonsusceptible organisms, including fungi. Pregnancy and lactation.

Significant: Hypersensitivity reaction (e.g. angioedema, swelling, conjunctival erythema), local sensitisation (e.g. reddening, pruritus, oedema), superinfection (prolonged use).
Eye disorders: Local irritation, stinging or burning sensation, inflammation.
Skin and subcutaneous tissue disorders: Rash, urticaria, vesicular eruption.

Ophth: C

Remove contact lenses prior to ophthalmic administration and reinsert after 15 minutes.

Monitor for signs and symptoms of hypersensitivity.

Neomycin and Polymyxin B: Increased risk of respiratory depression and apnoea with neuromuscular blocking agents.

Description:
Mechanism of Action: Neomycin, an aminoglycoside antibacterial, is bactericidal against a variety of gram-positive and gram-negative organisms. It inhibits bacterial protein synthesis by irreversibly binding to the cell’s 30S ribosomal ribonucleic acid subunits.
Polymyxin B, a lipopeptide antibacterial, is effective against a variety of gram-negative organisms. It damages the bacterial cell membrane by binding to the membrane’s phospholipids that causes leakage of intracellular contents.
Gramicidin, a polypeptide antibacterial, is effective against a variety of gram-positive organisms. It damages the bacterial cell membrane by forming channels through the membrane that increases its permeability to inorganic cations.
Pharmacokinetics:
Distribution: Polymyxin B: Widely distributed and extensively bound to cell membranes in the tissues.
Excretion: Neomycin: Via urine. Elimination half-life: 2-3 hours.
Polymyxin B: Via urine (Approx 60% as unchanged drug). Elimination half-life: Approx 6 hours.

Source: National Center for Biotechnology Information. PubChem Database. Neomycin, CID=8378, https://pubchem.ncbi.nlm.nih.gov/compound/Neomycin (accessed on Jan. 21, 2020)

Source: National Center for Biotechnology Information. PubChem Database. Polymyxin b, CID=49800004, https://pubchem.ncbi.nlm.nih.gov/compound/Polymyxin-b (accessed on Jan. 21, 2020)

Store between 15-25°C. Protect from light.

Eye Anti-Infectives & Antiseptics

Anon. Neomycin Sulfate (EENT). AHFS Clinical Drug Information [online]. Bethesda, MD. American Society of Health-System Pharmacists, Inc. https://www.ahfscdi.com. Accessed 13/04/2018.

Anon. Neomycin, Polymyxin B, and Gramicidin. Lexicomp Online. Hudson, Ohio. Wolters Kluwer Clinical Drug Information, Inc. https://online.lexi.com. Accessed 06/04/2018.

Anon. Polymyxin B (EENT). AHFS Clinical Drug Information [online]. Bethesda, MD. American Society of Health-System Pharmacists, Inc. https://www.ahfscdi.com. Accessed 13/04/2018.

Buckingham R (ed). Gramicidin. Martindale: The Complete Drug Reference [online]. London. Pharmaceutical Press. https://www.medicinescomplete.com. Accessed 06/04/2018.

Buckingham R (ed). Neomycin. Martindale: The Complete Drug Reference [online]. London. Pharmaceutical Press. https://www.medicinescomplete.com. Accessed 06/04/2018.

Buckingham R (ed). Polymyxin B Sulfate. Martindale: The Complete Drug Reference [online]. London. Pharmaceutical Press. https://www.medicinescomplete.com. Accessed 06/04/2018.

Neomycin and Polymyxin B Sulfates and Gramicidin Solution/Drops (A-S Medication Solutions). DailyMed. Source: U.S. National Library of Medicine. https://dailymed.nlm.nih.gov/dailymed/. Accessed 06/04/2018.