Neomycin

Aminoglycoside activity was reported to be diminished in a few patients with severe renal impairment.

Care should be taken when considering the use of neomycin concurrently with drugs with a potential to cause ototoxicity (including loop diuretics, capreomycin, teicoplanin, vancomycin and possibly platinum compounds).

The efficacy of oral contraceptives may be reduced with broad spectrum antibiotics.

Aminoglycosides exhibit synergistic activity with a number of beta lactams.

Care should be taken when considering the use of neomycin concurrently with drugs with a potential to cause nephrotoxicity (including other aminoglycosides, some of the cephalosporins, amphotericin, ciclosporin, capreomycin, polymixins, platinum compounds, teicoplanin and vancomycin).

Oral typhoid vaccine is inactivated by concomitant antibiotic administration.

Aminoglycosides may increase the risk of hypocalcaemia in patients receiving bisphosphonates.

Care is required when patients being treated with aminoglycosides are to receive a general anaesthetic or opioids in order to avoid the possible neuromuscular side-effects provoking severe respiratory depression.

The effect of non-depolarising muscle relaxants may be enhanced by aminoglycosides.

The hypoglycaemic effect of acarbose may be enhanced by neomycin and the severity of gastrointestinal side effects increased.

Care is required if other drugs with a neuromuscular blocking action, including botulinum toxic, are given concomitantly with neomycin.

There is almost complete cross-resistance between neomycin, kanamycin, paromomycin and framycetin. Crossresistance with gentamicin has also been reported.

The effect of the parasympathomimetic drugs neostigmine and pyridostigmine, may be antagonised by aminoglycosides.

Neomycin may impair absorption of other drugs including phenoxymethylpenicillin, digoxin, methotrexate and some vitamins.

Experience in anticoagulant clinics suggests that INR (International Normalised Ratio) may be altered by antibacterials such as neomycin given for local action on the gut.

Neomycin should be used with caution in patients with neuromuscular disorders and Parkinsonism.

The use of neomycin in pregnancy is not recommended unless the benefits outweigh the potential risks.

There are no reports linking the use of neomycin to congenital defects. However, small amounts of the drug are absorbed when given orally and neomycin and other aminoglycosides may have harmful effects on the foetus following oral absorption during pregnancy.

In some circumstances neomycin may enter the breast milk of lactating mothers. There is little risk of ototoxicity in the infant, but abnormal development of the gut flora may occur. The use of neomycin in lactating mothers is not recommended unless the benefits outweigh the potential risks.

Not applicable.

Nausea, vomiting, diarrhoea, increased salivation, stomatitis, nephrotoxicity, ototoxicity, rise in serum levels of hepatic enzymes and bilirubin, blood dyscrasias, haemolytic anaemia, confusion, paraesthesia, disorientation, nystagmus, hypersensitivity reactions including dermatitis, pruritus, drug fever and anaphylaxis.

Cross-sensitivity with other aminoglycosides may occur.

Malabsorption syndrome with steatorrhoea and diarrhoea, which can be severe, may be caused by prolonged oral therapy.

Superinfection may occur, especially with prolonged oral treatment.

Electrolyte disturbances (notably hypomagnesaemia but also hypocalcaemia and hypokalaemia) have occurred with other aminoglycosides.