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Topical ointment: Dermatologic: Acneiform eruptions, allergic contact dermatitis, burning skin, dryness, folliculitis, hypertrichosis, hypopigmentation, irritation, maceration of skin, miliaria, ocular hypertension, perioral dermatitis, pruritus, skin atrophy, striae Otic: Ototoxicity Renal: Nephrotoxicity Miscellaneous: Hypersensitivity (including anaphylaxis), secondary infection, sensitization to karamycin, paromycin, streptomycin, and gentamicin Contraindications Hypersensitivity to bacitracin, neomycin, polymyxin B, hydrocortisone, or any component; not for use in viral infections, fungal diseases, mycobacterial infections, or if eardrum is perforated (topical) Precautions Use with caution in glaucoma; avoid use following ocular cataract surgery; inadvertent contamination of multiple-dose ophthalmic products has caused bacterial keratitis Warnings Neomycin may cause cutaneous and conjunctival sensitization presenting as itching, reddening, edema, and failure to heal. Neomycin may cause permanent hearing loss; risk of ototoxicity is increased in patients with longstanding otitis media or tympanic perforation. Systemic absorption of hydrocortisone may cause hyperglycemia, glycosuria, fluid and electrolyte changes and HPA axis suppression which can lead to adrenal crisis; risk is increased when used over large surface areas, for prolonged periods, or with occlusive dressings; children are more susceptible to topical corticosteroid-induced HPA axis suppression and Cushing's syndrome; prolonged use of corticosteroids may also increase the incidence of secondary infection, mask acute infection (including fungal infections), prolong or exacerbate viral infections, or limit response to vaccines; prolonged treatment with corticosteroids has been associated with the development of Kaposi's sarcoma (case reports); if noted, discontinuation of therapy should be considered. Ophthalmic ointment: Should never be directly introduced into the anterior chamber; may delay corneal healing. Prolonged use may result in ocular hypertension/glaucoma, corneal and scleral thinning, potentially resulting in perforation. Metabolism/Transport Effects Refer to individual components. Drug Interactions (For additional information: Launch Lexi-Interact™ Drug Interactions Program )

Ophthalmic ointment: Should never be directly introduced into the anterior chamber; may delay corneal healing. Prolonged use may result in ocular hypertension/glaucoma, corneal and scleral thinning, potentially resulting in perforation. Metabolism/Transport Effects Refer to individual components. 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 Aldesleukin: Corticosteroids may diminish the antineoplastic effect of Aldesleukin. Risk X: Avoid combination 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 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

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 Corticorelin: Corticosteroids may diminish the therapeutic effect of Corticorelin. Specifically, the plasma ACTH response to corticorelin may be blunted by recent or current corticosteroid therapy. Risk C: Monitor therapy CycloSPORINE (Systemic): Aminoglycosides may enhance the nephrotoxic effect of CycloSPORINE (Systemic). Risk C: Monitor therapy Deferasirox: Corticosteroids may enhance the adverse/toxic effect of Deferasirox. Specifically, the risk for GI ulceration/irritation or GI bleeding may be increased. Risk C: Monitor therapy Gallium Nitrate: Aminoglycosides may enhance the nephrotoxic effect of Gallium Nitrate. Risk X: Avoid combination Hyaluronidase: Corticosteroids may diminish the therapeutic effect of Hyaluronidase. Management: Patients receiving corticosteroids (particularly at larger doses) may not experience the desired clinical response to standard doses of hyaluronidase. Larger doses of hyaluronidase may be required. Risk D: Consider therapy modification 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 Telaprevir: Corticosteroids may decrease the serum concentration of Telaprevir. Telaprevir may increase the serum concentration of Corticosteroids. Management: Concurrent use of telaprevir and systemic corticosteroids is not recommended. When possible, consider alternatives. If used together, employ extra caution and monitor closely for excessive corticosteroid effects and diminished telaprevir effects. Risk D: Consider therapy modification 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 Adverse events have been observed with topical corticosteroids in animal reproduction studies. See individual agents. Monitoring Parameters If ophthalmic ointment is used >10 days or in patients with glaucoma, monitor intraocular pressure (IOP). Mechanism of Action Refer to individual monographs for Bacitracin, Neomycin, Polymyxin B, and Hydrocortisone Pharmacokinetics (Adult data unless noted) See individual agents. Patient Information (For additional information see "Bacitracin, neomycin, polymyxin B, and hydrocortisone: Patient drug information" ) See individual agents.

Pregnancy/breast-feeding precautions: Inform prescriber if you are or intend to become pregnant. Consult prescriber if breast-feeding. Use of UpToDate is subject to the Subscription and License Agreement . Topic 15944 Version 26.0 © 2013 UpToDate, Inc. All rights reserved. | Subscription and License Agreement | Release: 21.4 - C21.36 Licensed to: Southeast Alabama Med Ctr | Support Tag: [0604-122.72.80.101-9C98E7F444-S244013.14]