Neomycin

INTRODUCTION

Indications

Preparation of the GI tract for surgery. Treatment of diarrhea caused by Escherichia coli. To decrease the number of ammonia-producing bacteria in the gut as part of the management of hepatic encephalopathy.

Action

Inhibits protein synthesis in bacteria at level of 30S ribosome. Therapeutic Effects: Bactericidal action. Spectrum: Notable for activity against Klebsiella pneumoniae, E. coli, Proteus, Serratia, Acinetobacter, Staphylococcus aureus.

Adverse Reactions/Side Effects

GI: diarrhea, nausea, vomiting. Misc: hypersensitivity reactions.

PHYSICAL THERAPY IMPLICATIONS

Examination and Evaluation

• Monitor signs of hypersensitivity reactions, including pulmonary symptoms (tightness in the throat and chest, wheezing, cough dyspnea) or skin reactions (rash, pruritus, urticaria). Notify physician or nursing staff immediately if these reactions occur.

Interventions

• Always wash hands thoroughly and disinfect equipment (whirlpools, electrotherapeutic devices, treatment tables, and so forth) to help prevent the spread of infection. Use universal precautions or isolation procedures as indicated for specific patients.

Patient/Client-Related Instruction

• Advise patient about the likelihood of GI reactions, including diarrhea, nausea, and vomiting. Instruct patient to report severe or prolonged GI problems.

Pharmacokinetics

Absorption: Minimal systemic absorption, but may accumulate in patients with renal failure.

Distribution: Widely distributed throughout extracellular fluid; crosses the placenta; small amounts enter breast milk. Poor penetration into CSF.

Metabolism and Excretion: Excretion is >90% renal.

Half-life: 2–4 hr (increased in renal impairment).

Contraindications/Precautions

Contraindicated in: Hypersensitivity to neomycin or other aminoglycosides; Intestinal obstruction.

Use Cautiously in: Renal impairment (lower doses are recommended); Hearing impairment; Geriatric patients; Neuromuscular diseases such as myasthenia gravis; Pregnancy, lactation, infants, and neonates (safety not established).

Interactions

Interactions are listed for systemically absorbed drug

Drug-Drug: May enhance possible respiratory paralysis after inhalation anesthetics or neuromuscular blockers. ↑ incidence of ototoxicity with loop diuretics. ↑ incidence of nephrotoxicity with other nephrotoxic drugs. May ↑ the anticoagulant effects of warfarin. May ↓ the absorption of digoxin and methotrexate.

Route/Dosage

Preoperative Intestinal Antisepsis

PO (Adults): 1 g q hr for 4 doses, then 1 g q 4 hr for 5 doses or 1 g at 1 PM, 2 PM, and 11 PM on day before surgery.

PO (Children): 15 mg/kg q 4 hr for ...