Drug Guide
Neomycin Sulfate
Classification
Therapeutic: Antibiotic, Aminoglycoside
Pharmacological: Lytic Antibiotic
FDA Approved Indications
- Preparation of bowel for surgery or diagnostic procedures
- Eradication of certain bacterial infections in the GI tract
Mechanism of Action
Neomycin binds to bacterial 30S ribosomal subunit, inhibiting protein synthesis, leading to bacterial cell death.
Dosage and Administration
Adult: Dosage varies based on indication; typically, 1 gram 3-4 times daily, administered orally or via enemas during bowel preparation.
Pediatric: Dosage depends on age and weight; must be determined by a physician.
Geriatric: Dose adjustments may be necessary due to renal function; monitor renal status.
Renal Impairment: Use with caution; may require dose adjustment and renal function monitoring.
Hepatic Impairment: No specific dosage adjustment required.
Pharmacokinetics
Absorption: Poorly absorbed from gastrointestinal tract
Distribution: Limited to GI tract, negligible systemic absorption when used orally
Metabolism: Not metabolized
Excretion: Primarily excreted unchanged in urine
Half Life: Approximately 2-3 hours in normal renal function
Contraindications
- Hypersensitivity to neomycin or other aminoglycosides
- Perforated bowel or signs of bowel perforation
Precautions
- Potential nephrotoxicity and ototoxicity, especially with systemic absorption or prolonged use.
- Use cautiously in patients with renal impairment.
- Monitor renal function during therapy.
Adverse Reactions - Common
- Gastrointestinal upset, nausea, vomiting (Common)
- Nephrotoxicity (Rare with oral use)
- Ototoxicity (Rare)
Adverse Reactions - Serious
- Nephrotoxicity, ototoxicity with systemic absorption (Rare)
- Hypersensitivity reactions (rash, itching) (Rare)
Drug-Drug Interactions
- Concurrent use with other nephrotoxic or ototoxic drugs (e.g., loop diuretics, amphotericin B) increases risk.
Drug-Food Interactions
- No significant interactions reported.
Drug-Herb Interactions
- Limited data but exercise caution with herbal nephrotoxins.
Nursing Implications
Assessment: Baseline renal function, hearing status, and neurotoxicity risk.
Diagnoses:
- Risk for renal impairment
- Risk for ototoxicity
Implementation: Monitor renal function and hearing during prolonged therapy or high doses. Ensure proper dosing based on renal function.
Evaluation: Assess for signs of renal or auditory toxicity, effectiveness of bowel preparation.
Patient/Family Teaching
- Report any hearing changes, dizziness, or signs of kidney problems.
- Take medication exactly as prescribed, do not double doses.
- Maintain adequate hydration during therapy.
Special Considerations
Black Box Warnings:
- Potential for ototoxicity and nephrotoxicity, especially with systemic absorption.
- Use only when clearly indicated, and with caution.
Genetic Factors: No specific genetic markers identified.
Lab Test Interference: May cause elevated serum creatinine and BUN, misleading assessment of renal function.
Overdose Management
Signs/Symptoms: Auditory or renal toxicity; neuromuscular blockade in overdose.
Treatment: Discontinue drug; supportive care; in severe cases, hemodialysis may be considered.
Storage and Handling
Storage: Store at room temperature, 20-25°C (68-77°F).
Stability: Stable when stored properly.