Neomycin
Regulatory sources consulted
Approved indications
- Pre-operative intestinal decontamination in adults.
- Hyperammonaemia and hepatic conditions caused by it, such as hepatic encephalopathy, in adults.
Contraindications
Absolute
- Hypersensitivity to neomycin, other aminoglycosides or excipients; intestinal obstruction; ulcerative intestinal disease; hearing impairment.
Clinical warnings
- Major warning · It may cause nephrotoxicity and ototoxicity; monitor renal, vestibular and auditory function. Risk increases with high doses, dehydration, older age, reduced gastrointestinal motility or intestinal lesions. — AEMPS CIMA, Neomicina Salvat, ficha técnica 45462, sección 4.4
- Major warning · Avoid high doses or prolonged treatment because of malabsorption, steatorrhoea and resistant-strain selection risk. — AEMPS CIMA, Neomicina Salvat, ficha técnica 45462, sección 4.4
- Major warning · In myasthenia gravis or parkinsonism, aminoglycosides may cause neuromuscular blockade and worsen weakness; discontinue if respiratory paralysis signs occur. — AEMPS CIMA, Neomicina Salvat, ficha técnica 45462, sección 4.4
Drug interactions
- HighAminoglycosides, loop diuretics, cephalosporins, amphotericin B, ciclosporin, polymyxins, cisplatin, glycopeptides and bacitracin
Mechanism: Neomycin increases nephrotoxicity and, with loop diuretics, aminoglycosides, glycopeptides or cisplatin, also ototoxicity.
Recommendation: Avoid these combinations where possible. If essential, closely monitor renal and auditory function; with colistin also monitor neuromuscular blockade and respiratory paralysis.
https://cima.aemps.es/cima/dochtml/ft/45462/FT_45462.html
- HighOral anticoagulants
Mechanism: Neomycin may alter vitamin K availability and increase bleeding risk.
Recommendation: Monitor INR and clinical bleeding; adjust anticoagulant treatment as needed.
https://cima.aemps.es/cima/dochtml/ft/45462/FT_45462.html
- HighNeuromuscular blockers, anaesthetics and opioids
Mechanism: Neomycin can potentiate neuromuscular blockade and respiratory depression.
Recommendation: Avoid where possible; use with close respiratory and neuromuscular monitoring.
https://cima.aemps.es/cima/dochtml/ft/45462/FT_45462.html
- ModerateDigoxin
Mechanism: Neomycin may reduce digoxin absorption.
Recommendation: Separate administration and monitor clinical response and digoxin concentrations where appropriate.
https://cima.aemps.es/cima/dochtml/ft/45462/FT_45462.html
- ModerateOral typhoid vaccine
Mechanism: Antibacterial activity can inactivate the live oral typhoid vaccine.
Recommendation: Do not administer concomitantly; follow the vaccine timing recommendations.
https://cima.aemps.es/cima/dochtml/ft/45462/FT_45462.html
Adverse events
Common (≥1%)
Nausea · Diarrhoea · Fungal superinfections
Rare but serious
Nephrotoxicity · Ototoxicity · Neuromuscular blockade · Anaphylaxis
Pregnancy and lactation
Do not use during pregnancy unless the clinical situation requires neomycin; aminoglycosides cross the placenta and may cause fetal toxicity, especially ototoxicity. During breastfeeding, decide whether to stop breastfeeding or treatment after weighing benefits and risks.
Recent literature (PubMed)
This review highlights the causes, types and clinical staging of hepatic encephalopathy (HE). Current concepts on the probable pathogenetic mechanisms and currently practiced therapeutic options are discussed. HE may be covert and overt. Also known as minimal HE. Covert HE, where there are behavioral abnormalities and impairment in activities of daily living with intact sensorium. The pathophysiology of HE remains poorly understood. There is disturbance of the urea cycle due to liver disease leading to increased production of ammonia. The ammonium ion enters the astrocytes along with glutamate (converted to glutamine by ammonia) and myo-inositol, thereby increasing the osmolality of the astrocytic cytoplasm. This osmotic gradient results in accumulation of water inside the astrocytes resulting in cerebral edema and increase in brain volume. Additionally, current research has noted the role of cerebral oxidative/nitrosative stress and the synergistic effects of increased cerebral ammonia and alteration in neurotransmitters, neurometabolites, and cortical excitability due to systemic inflammation. In advanced liver disease with systemic infection or inflammation, neuroinflammatory processes play significant role in the development of HE. Inflammatory cytokines like TNF-α, IL-6, IL-17 in presence of hyperammonemia have been found to induce neurotoxicity of ammonia by passing through the blood brain barrier and causing enlarged/swollen pale astrocytes, resulting in HE. Disrupted enterohepatic circulation in end stage liver disease also causes elevation of bile acids which induces neuroinflammation. Manganese and zinc play as co-factors of enzymatic reaction. These metal deposition causes multiple psychomotor symptoms observed in HE. The gut environment has a major impact on brain function in patients with HE. Toxins such as ammonia and inflammatory cytokines produced by this impaired intestinal flora access the circulation through porto-systemic anastomoses and exacerba
Surgical site infections (SSIs)-especially anastomotic dehiscence-are major contributors to morbidity and mortality after rectal resection. The role of mechanical and oral antibiotics bowel preparation (MOABP) in preventing complications of rectal resection is currently disputed. To assess whether MOABP reduces overall complications and SSIs after elective rectal resection compared with mechanical bowel preparation (MBP) plus placebo. This multicenter, double-blind, placebo-controlled randomized clinical trial was conducted at 3 university hospitals in Finland between March 18, 2020, and October 10, 2022. Patients aged 18 years and older undergoing elective resection with primary anastomosis of a rectal tumor 15 cm or less from the anal verge on magnetic resonance imaging were eligible for inclusion. Outcomes were analyzed using a modified intention-to-treat principle, which included all patients who were randomly allocated to and underwent elective rectal resection with an anastomosis. Patients were stratified according to tumor distance from the anal verge and neoadjuvant treatment given and randomized in a 1:1 ratio to receive MOABP with an oral regimen of neomycin and metronidazole (n = 277) or MBP plus matching placebo tablets (n = 288). All study medications were taken the day before surgery, and all patients received intravenous antibiotics approximately 30 minutes before surgery. The primary outcome was overall cumulative postoperative complications measured using the Comprehensive Complication Index. Key secondary outcomes were SSI and anastomotic dehiscence within 30 days after surgery. In all, 565 patients were included in the analysis, with 288 in the MBP plus placebo group (median [IQR] age, 69 [62-74] years; 190 males [66.0%]) and 277 in the MOABP group (median [IQR] age, 70 [62-75] years; 158 males [57.0%]). Patients in the MOABP group experienced fewer overall postoperative complications (median [IQR] Comprehensive Complication Index, 0 [0-8.66] vs 8