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Superficial dermal infection: Topical: Apply 1-3 times/day to infected area; may cover with sterile bandage if necessary. Dosing: Pediatric (For additional information see "Bacitracin, neomycin, and polymyxin B: Pediatric drug information" ) Refer to adult dosing. Dosing: Geriatric Refer to adult dosing. Dosage Forms: U.S. Excipient information presented when available (limited, particularly for generics); consult specific product labeling. Ointment, ophthalmic: Bacitracin 400 units, neomycin 3.5 mg, and polymyxin B 10,000 units per g (3.5 g) Neo-Polycin™: Bacitracin 400 units, neomycin 3.5 mg, and polymyxin B 10,000 units per g (3.5 g) Ointment, topical: Bacitracin 400 units, neomycin 3.5 mg, and polymyxin B 5000 units per g (0.9 g, 15 g, 30 g, 454 g) Neosporin®: Bacitracin 400 units, neomycin 3.5 mg, and polymyxin B 5000 units per g (15 g, 30 g) Neosporin® Neo To Go®: Bacitracin 400 units, neomycin 3.5 mg, and polymyxin B 5000 units per g (0.9 g) Generic Equivalent Available: U.S. Yes Use Helps prevent infection in minor cuts, scrapes, and burns; short-term treatment of superficial external ocular infections caused by susceptible organisms Adverse Reactions Significant Frequency not defined. Dermatologic: Reddening, allergic contact dermatitis Local: Itching, failure to heal, swelling, irritation Ophthalmic: Conjunctival edema Miscellaneous: Anaphylaxis Contraindications Hypersensitivity to neomycin, polymyxin B, zinc bacitracin, or any component of the formulation; epithelial herpes simplex keratitis; mycobacterial or fungal infections; topical ointments for external use only Warnings/Precautions

Dosage form specific issues: • Ophthalmic ointment: Bacterial keratitis has been reported with the use of topical ophthalmic products in multiple-dose containers. Care should be taken to not contaminate the container. • Topical ointment: When used for self-medication (OTC use), patients should notify healthcare provider if needed for >1 week. Should not be used for self-medication on deep or puncture wounds, animal bites, or serious burns. Not for application to large areas of the body. Metabolism/Transport Effects None known. Drug Interactions (For additional information: Launch Lexi-Interact™ Drug Interactions Program ) AbobotulinumtoxinA: Aminoglycosides may enhance the neuromuscular-blocking effect of AbobotulinumtoxinA. Risk C: Monitor therapy Acarbose: Neomycin may enhance the adverse/toxic effect of Acarbose. Neomycin may enhance the therapeutic effect of Acarbose. Neomycin may decrease the metabolism of Acarbose. Risk C: Monitor therapy Amphotericin B: May enhance the nephrotoxic effect of Aminoglycosides. Risk C: Monitor therapy BCG: Antibiotics may diminish the therapeutic effect of BCG. Risk X: Avoid combination Bisphosphonate Derivatives: Aminoglycosides may enhance the hypocalcemic effect of Bisphosphonate Derivatives. Risk C: Monitor therapy Capreomycin: May enhance the neuromuscular-blocking effect of Polymyxin B. Risk C: Monitor therapy Capreomycin: May enhance the neuromuscular-blocking effect of Aminoglycosides. Risk C: Monitor therapy CARBOplatin: Aminoglycosides may enhance the ototoxic effect of CARBOplatin. Especially with higher doses of carboplatin. Risk C: Monitor therapy Cardiac Glycosides: Aminoglycosides may decrease the serum concentration of Cardiac Glycosides. This effect has only been demonstrated with oral aminoglycoside administration. Risk C: Monitor therapy Cephalosporins (2nd Generation): May enhance the nephrotoxic effect of Aminoglycosides. Risk C: Monitor therapy Cephalosporins (3rd Generation): May enhance the nephrotoxic effect of Aminoglycosides. Risk C: Monitor therapy Cephalosporins (4th Generation): May enhance the nephrotoxic effect of Aminoglycosides. Risk C: Monitor therapy CISplatin: May enhance the nephrotoxic effect of Aminoglycosides. Risk C: Monitor therapy

Cephalosporins (2nd Generation): May enhance the nephrotoxic effect of Aminoglycosides. Risk C: Monitor therapy Cephalosporins (3rd Generation): May enhance the nephrotoxic effect of Aminoglycosides. Risk C: Monitor therapy Cephalosporins (4th Generation): May enhance the nephrotoxic effect of Aminoglycosides. Risk C: Monitor therapy CISplatin: May enhance the nephrotoxic effect of Aminoglycosides. Risk C: Monitor therapy Colistimethate: Aminoglycosides may enhance the nephrotoxic effect of Colistimethate. Aminoglycosides may enhance the neuromuscular-blocking effect of Colistimethate. Risk D: Consider therapy modification Colistimethate: Polymyxin B may enhance the neuromuscular-blocking effect of Colistimethate. Risk C: Monitor therapy CycloSPORINE (Systemic): Aminoglycosides may enhance the nephrotoxic effect of CycloSPORINE (Systemic). Risk C: Monitor therapy Gallium Nitrate: Aminoglycosides may enhance the nephrotoxic effect of Gallium Nitrate. Risk X: Avoid combination Loop Diuretics: May enhance the adverse/toxic effect of Aminoglycosides. Specifically, nephrotoxicity and ototoxicity. Risk C: Monitor therapy Neuromuscular-Blocking Agents: Polymyxin B may enhance the neuromuscular-blocking effect of Neuromuscular-Blocking Agents. Risk D: Consider therapy modification Neuromuscular-Blocking Agents: Aminoglycosides may enhance the respiratory depressant effect of Neuromuscular-Blocking Agents. Risk C: Monitor therapy Nonsteroidal Anti-Inflammatory Agents: May decrease the excretion of Aminoglycosides. Data only in premature infants. Risk C: Monitor therapy OnabotulinumtoxinA: Aminoglycosides may enhance the neuromuscular-blocking effect of OnabotulinumtoxinA. Risk C: Monitor therapy Penicillins: May decrease the serum concentration of Aminoglycosides. Primarily associated with extended spectrum penicillins, and patients with renal dysfunction.

Exceptions: Amoxicillin; Ampicillin; Cloxacillin; Dicloxacillin; Nafcillin; Oxacillin; Penicillin G (Parenteral/Aqueous); Penicillin G Benzathine; Penicillin G Procaine; Penicillin V Potassium. Risk D: Consider therapy modification RimabotulinumtoxinB: Aminoglycosides may enhance the neuromuscular-blocking effect of RimabotulinumtoxinB. Risk C: Monitor therapy Sodium Picosulfate: Antibiotics may diminish the therapeutic effect of Sodium Picosulfate. Management: Consider using an alternative product for bowel cleansing prior to a colonoscopy in patients who have recently used or are concurrently using an antibiotic. Risk D: Consider therapy modification SORAfenib: Neomycin may decrease the serum concentration of SORAfenib. Risk C: Monitor therapy Vancomycin: May enhance the nephrotoxic effect of Aminoglycosides. Risk C: Monitor therapy Vitamin K Antagonists (eg, warfarin): Neomycin may enhance the anticoagulant effect of Vitamin K Antagonists. Risk C: Monitor therapy Pregnancy Risk Factor C ( show table ) Pregnancy Implications Animal reproduction studies have not been conducted with this combination. See individual agents. Lactation Excretion in breast milk unknown/use caution Breast-Feeding Considerations It is not known if bacitracin, neomycin, or polymyxin B is excreted into breast milk. The manufacturer recommends that caution be exercised when administering to nursing women. See individual agents. Pricing: U.S. (Medi-Span®)

Ointment (Neosporin Original External) 3.5-400-5000 (1): $0.22 3.5-400-5000 (14.2 g): $3.98 International Brand Names Bamyxin (IL); My-B (TH); Neo-Polybacin (AE, BF, BH, BJ, CI, CY, EG, ET, GH, GM, GN, IQ, IR, JO, KE, KW, LB, LR, LY, MA, ML, MR, MU, MW, NE, NG, OM, QA, SA, SC, SD, SL, SN, SY, TN, TZ, UG, YE, ZA, ZM, ZW); Neosporin Dermico (MX); Neosporin Ophthalmic Ointment (AU, IN); Novosporina (PY); Polixin Ungena (MX); Polybamycin (MY, SG); Polysporin (BR); Spersin (NZ); Terramycin Plus (PH); Tigalin (ID); Topimicyn (PE); Tribiot (MX); Yentuogin (TW) Mechanism of Action See individual agents. Pharmacodynamics/Kinetics See individual agents. Use of UpToDate is subject to the Subscription and License Agreement . Topic 9058 Version 34.0 © 2013 UpToDate, Inc. All rights reserved. | Subscription and License Agreement | Release: 21.6- C21.56 Licensed to: AsanBook Dig. Med. Lib. | Support Tag: [0503-89.32.226.102-21F53BA666-S244013.14]