Neosporin GU

Urinary Antibiotics and/or Sulfonamides

 
NOTE: This monograph discusses the use of the combination product neomycin; polymyxin B genitourinary (GU) irrigant solution for prophylaxis of infections associated with use of indwelling catheters. Clinicians may wish to consult the individual drug monographs for more information.
 
NOTE: 57 mg of neomycin sulfate is equivalent to 40 mg of neomycin base and 200,000 units of polymyxin B sulfate is equivalent to 20 mg of polymyxin B base.

Bladder Irrigation
Follow strict aseptic techniques.
Administer via a 3-way catheter or other catheter system permitting continuous irrigation of the urinary bladder. The inflow of the solution should not be interrupted for more than a few minutes.
Dilute 1 ml of neomycin; polymyxin B irrigant (equivalent to 40 mg neomycin base and 200,000 units polymyxin B) in a 1000 ml container of sterile 0.9% Sodium Chloride (NS).
Connect the container to the inflow lumen of the 3-way catheter. The outflow lumen should be connected, via a sterile disposable plastic tube, to a disposable plastic collection bag. Tape the inflow and outflow junction at the catheter to insure the junctional integrity of the system.
Adjust the inflow rate to a slow drip to deliver 1 L/24 h (roughly 40 ml/h). If the patient's urine output exceeds 2 L/d, the manufacturer recommends that the inflow rate be adjusted to 2 L/24 h.
The undiluted vials and prepared irrigation solution should be stored under refrigeration (2—8 degrees C or 36—46 degrees F). The irrigation solution should be used within 48 hours of preparation.

superinfection / Delayed / Incidence not known
candidiasis / Delayed / Incidence not known

pruritus / Rapid / Incidence not known

Neosporin GU

Rx

Urinary bladder irrigation to prevent infections due to indwelling catheters. For short-term use (up to 10 days).

Neomycin base 40 mg/day and polymyxin B 200,000 units/day as a continuous bladder irrigation. Administration rate is adjusted to patient's urine output.

No dosage guidelines are available; it appears no dosage adjustment is needed.

No dosage guidelines are available; it appears no dosage adjustment is needed.

There are no drug interactions associated with Neomycin; Polymyxin B products.

Neomycin, Polymyxin B/Neosporin GU Intravesical Sol: 1mL, 40-200000U
Neomycin, Polymyxin B/Neosporin GU Irrigation Sol: 1mL, 40-200000U

2 million units of polymyxin B/day (topical and systemic); maximum dose information is not available for Neosporin.

2 million units of polymyxin B/day (topical and systemic); maximum dose information is not available for Neosporin.

Safety and efficacy have not been established.

Safety and efficacy have not been established.

Mechanism of Action: Neomycin and polymyxin B are combined in a single irrigating solution to prevent bacteriuria and gram-negative rod septicemia associated with the use of indwelling catheters. The combined action of neomycin and polymyxin B is bactericidal.•Neomycin sulfate: Neomycin inhibits bacterial protein synthesis through irreversible binding to the 30 S ribosomal subunit of susceptible bacteria. Neomycin is actively transported into the bacterial cell where it binds to receptors present on the 30 S ribosomal subunit. This binding interferes with the initiation complex between the messenger RNA and the subunit. As a result, abnormal, nonfunctional proteins are formed due to misreading of the bacterial DNA. Eventually, susceptible bacteria die because of the lack of functional proteins.•Polymyxin B sulfate: Polymyxin B binds to gram-negative bacterial cell membrane phospholipids. This binding destroys bacterial membranes with a surface detergent-like mechanism and increases the permeability of the cell membrane, which results in loss of metabolites essential to bacterial existence. Polymyxin B has no in vitro activity against gram-positive organisms or fungi. The in vivo activity of polymyxin B against Pseudomonas aeruginosa is decreased by the presence of divalent cations such as calcium, which is believed to interfere with the binding of the drug to the cell membrane.The following organisms are generally considered susceptible to neomycin; polymyxin B GU irrigant in-vitro: Enterobacter sp.; Escherichia coli; Haemophilus influenzae (beta-lactamase negative); Haemophilus influenzae (beta-lactamase positive); Klebsiella sp.; Neisseria sp.; Pseudomonas aeruginosa; Staphylococcus aureus (MSSA). Neomycin; Polymyxin B GU irrigant is not active in-vitro against Serratia marcescens and streptococci.

Neomycin; polymyxin B is administered via continuous bladder irrigation.

Bladder Irrigation
Negligible systemic absorption of neomycin; polymyxin B GU irrigant occurs when administered to patients with intact bladders for <= 10 days. If systemic absorption should occur, significant neuro-, nephro- and ototoxicity may occur.
Neomycin sulfate: A neomycin serum level of 0.1 mcg/ml has been observed with bladder irrigation, which is well below the limit associated with neomycin-induced toxicity.
Polymyxin B sulfate: After prophylactic irrigation of the intact urinary bladder, polymyxin B is systemically absorbed in clinically insignificant quantities.

Neomycin; polymyxin B is used as a genitourinary irrigation. If the patient's bladder is intact and irrigation does not exceed 10 days per recommended use, the likelihood that the irrigant would be absorbed in significant quantities is remote. Systemically-absorbed neomycin crosses the placenta and aminoglycosides are known to cause fetal nephrotoxicity and permanent ototoxicity in children whose mothers received them during pregnancy. Systemic absorption of neomycin could occur if the mother's bladder was not intact. If neomycin; polymyxin B GU irrigant is used during pregnancy, the manufacturer recommends the patient should be informed of the potential hazard to the fetus.

Neomycin; polymyxin B is used as a genitourinary irrigation. If the mother's bladder is intact and irrigation does not exceed 10 days, the likelihood that the irrigant would be absorbed in significant quantities to adversely effect a nursing infant is remote. If systemic absorption by the mother did occur, there would be minimal oral absorption by the breast-feeding infant. Consider the benefits of breast-feeding, the risk of potential infant drug exposure, and the risk of an untreated or inadequately treated condition. If a breast-feeding infant experiences an adverse effect related to a maternally administered drug, healthcare providers are encouraged to report the adverse effect to the FDA.