Bacitracin, Neomycin, and Polymyxin B (Ophthalmic) (Lexi-Drugs)

Pronunciation

(bas i TRAY sin, nee oh MYE sin, & pol i MIKS in bee)

Brand Names: US

Neo-Polycin

Pharmacologic Category

Antibiotic, Ophthalmic

Dosing: Adult

Ocular infections: Ophthalmic: Apply every 3 to 4 hours for 7 to 10 days.

Dosing: Geriatric

Refer to adult dosing.

Dosing: Renal Impairment: Adult

There are no dosage adjustments provided in the manufacturer’s labeling.

Dosing: Hepatic Impairment: Adult

There are no dosage adjustments provided in the manufacturer’s labeling.

Dosing: Pediatric

Conjunctivitis: Limited data available: Children and Adolescents: Ophthalmic: Apply 0.5 inch ribbon every 3 to 4 hours for acute infections, or 2 to 3 times per day for mild to moderate infections, for 7 to 10 days (Pichichero 2011)

Dosing: Renal Impairment: Pediatric

There are no dosage adjustments provided in the manufacturer’s labeling.

Dosing: Hepatic Impairment: Pediatric

There are no dosage adjustments provided in the manufacturer’s labeling.

Use: Labeled Indications

Ocular infections: Treatment of superficial external ocular infections (eg, conjunctivitis, keratitis, keratoconjunctivitis, blepharitis, blepharoconjunctivitis) caused by susceptible organisms.

Administration: Ophthalmic

For ophthalmic use only; not for injection into the eye. Avoid contamination of the tip of the ointment tube.

Administration: Pediatric

Ophthalmic: Wash hands prior to application; avoid contamination of the tip of the ointment tube

Storage/Stability

Store at room temperature.

Medication Patient Education with HCAHPS Considerations

• Discuss specific use of drug and side effects with patient as it relates to treatment. (HCAHPS: During this hospital stay, were you given any medicine that you had not taken before? Before giving you any new medicine, how often did hospital staff tell you what the medicine was for? How often did hospital staff describe possible side effects in a way you could understand?)

• Have patient report immediately to prescriber vision changes, eye pain, severe eye irritation, or eye discharge (HCAHPS).

• Educate patient about signs of a significant reaction (eg, wheezing; chest tightness; fever; itching; bad cough; blue skin color; seizures; or swelling of face, lips, tongue, or throat). Note: This is not a comprehensive list of all side effects. Patient should consult prescriber for additional questions.

Intended Use and Disclaimer: Should not be printed and given to patients. This information is intended to serve as a concise initial reference for health care professionals to use when discussing medications with a patient. You must ultimately rely on your own discretion, experience, and judgment in diagnosing, treating, and advising patients.

Contraindications

Hypersensitivity to neomycin, polymyxin B, bacitracin, or any component of the formulation

Warnings/Precautions

Concerns related to adverse effects:

• Neomycin sensitization: Neomycin may cause cutaneous sensitization. Symptoms of neomycin sensitization include itching, reddening, edema, and failure to heal. Discontinuation of product and avoidance of similar products should be considered.

• Ocular effects: May retard corneal wound healing.

• Superinfection: Prolonged use may lead to overgrowth of nonsusceptible organisms, including fungi. If superinfection is suspected, institute appropriate alternative therapy.

Other warnings/precautions:

• Appropriate use: For topical ophthalmic use only. Do not introduce directly into anterior chamber of the eye. Inadvertent contamination of multiple-dose ophthalmic tube tip has caused bacterial keratitis.

Pregnancy Risk Factor

C

Pregnancy Considerations

Animal reproduction studies have not been conducted with this combination.

Breast-Feeding Considerations

It is not known if bacitracin, neomycin, or polymyxin B are excreted in breast milk. The manufacturer recommends that caution be exercised when administering to breastfeeding women.

Lexicomp Pregnancy & Lactation, In-Depth
Briggs’ Drugs in Pregnancy & Lactation
Adverse Reactions

Frequency not defined.

Dermatologic: Reddening, allergic contact dermatitis

Local: Itching, failure to heal, swelling, irritation

Ophthalmic: Conjunctival edema

Miscellaneous: Anaphylaxis

Allergy and Idiosyncratic Reactions
Metabolism/Transport Effects

None known.

Drug Interactions 

There are no known significant interactions.

Advanced Practitioners Physical Assessment/Monitoring

See individual agents.

Nursing Physical Assessment/Monitoring

See individual agents.

Dosage Forms: US

Excipient information presented when available (limited, particularly for generics); consult specific product labeling.

Ointment, Ophthalmic:

Neo-Polycin: Bacitracin 400 units, neomycin 3.5 mg, and polymyxin B 10,000 units per g (3.5 g)

Generic: Bacitracin 400 units, neomycin 3.5 mg, and polymyxin B 10,000 units per g (3.5 g)

Generic Available (US)

Yes

Pricing: US

Ointment (Neo-Polycin Ophthalmic)

3.5-400-10000 (per gram): $15.01

Ointment (Neomycin-Bacitracin Zn-Polymyx Ophthalmic)

5-400-10000 (per gram): $16.27

Disclaimer: A representative AWP (Average Wholesale Price) price or price range is provided as reference price only. A range is provided when more than one manufacturer’s AWP price is available and uses the low and high price reported by the manufacturers to determine the range. The pricing data should be used for benchmarking purposes only, and as such should not be used alone to set or adjudicate any prices for reimbursement or purchasing functions or considered to be an exact price for a single product and/or manufacturer. Medi-Span expressly disclaims all warranties of any kind or nature, whether express or implied, and assumes no liability with respect to accuracy of price or price range data published in its solutions. In no event shall Medi-Span be liable for special, indirect, incidental, or consequential damages arising from use of price or price range data. Pricing data is updated monthly.

Mechanism of Action

Bacitracin: Inhibits bacterial cell wall synthesis by preventing transfer of mucopeptides into the growing cell wall.

Neomycin: Interferes with bacterial protein synthesis by binding to 30S ribosomal subunits.

Polymyxin B: Binds to phospholipids, alters permeability, and damages the bacterial cytoplasmic membrane permitting leakage of intracellular constituents.

Pharmacodynamics/Kinetics

See individual agents.

Local Anesthetic/Vasoconstrictor Precautions

No information available to require special precautions

Effects on Dental Treatment

No significant effects or complications reported

Effects on Bleeding

No information available to require special precautions

Index Terms

Neomycin, Bacitracin, and Polymyxin B; Polymyxin B, Bacitracin, and Neomycin

References

Bacitracin zinc/neomycin sulfate/polymyxin b ophthalmic ointment [prescribing information]. Bridgewater, NJ: Bausch & Lomb; November 2016.

Neo-Polycin (bacitracin zinc/neomycin sulfate/polymyxin b) ophthalmic ointment [prescribing information]. Minneapolis, MN: Perrigo Company; November 2013.

Pichichero ME. Bacterial conjunctivitis in children: antibacterial treatment options in an era of increasing drug resistance. Clin Pediatr (Phila). 2011;50(1):7-13.[PubMed 20724317]10.1177/0009922810379045

Brand Names: International

Bamyxin (IL); Baneopol (CH); EFA Triple (UY); Glubacida (MX); Neopolybacin (EG); Oftabiotico (CL, PY, UY); Polyspectran (AE, DE); Polyspectran Eye & Ear Ointment (SA); Tribiot (MX)

Bacitracin, Neomycin, and Polymyxin B (Ophthalmic) (Patient Education – Adult Medication)
You must carefully read the “Consumer Information Use and Disclaimer” below in order to understand and correctly use this information
Pronunciation

(bas i TRAY sin, nee oh MYE sin, & pol i MIKS in bee)

Brand Names: US

Neo-Polycin

What is this drug used for?
  • It is used to treat eye infections.
What do I need to tell my doctor BEFORE I take this drug?
  • If you have an allergy to bacitracin, neomycin, polymyxin B, or any other part of this drug.
  • If you are allergic to any drugs like this one, any other drugs, foods, or other substances. Tell your doctor about the allergy and what signs you had, like rash; hives; itching; shortness of breath; wheezing; cough; swelling of face, lips, tongue, or throat; or any other signs.
  • If you have any of these health problems: Herpes, viral, or fungal infection of the eye.
  • This is not a list of all drugs or health problems that interact with this drug.
  • Tell your doctor and pharmacist about all of your drugs (prescription or OTC, natural products, vitamins) and health problems. You must check to make sure that it is safe for you to take this drug with all of your drugs and health problems. Do not start, stop, or change the dose of any drug without checking with your doctor.
What are some things I need to know or do while I take this drug?
  • Tell all of your health care providers that you take this drug. This includes your doctors, nurses, pharmacists, and dentists.
  • Avoid driving and doing other tasks or actions that call for you to be alert or have clear eyesight until you see how this drug affects you.
  • Avoid wearing contacts unless told to wear them by your doctor.
  • Do not use longer than you have been told. A second infection may happen.
  • Tell your doctor if you are pregnant or plan on getting pregnant. You will need to talk about the benefits and risks of using this drug while you are pregnant.
  • Tell your doctor if you are breast-feeding. You will need to talk about any risks to your baby.
What are some side effects that I need to call my doctor about right away?
  • WARNING/CAUTION: Even though it may be rare, some people may have very bad and sometimes deadly side effects when taking a drug. Tell your doctor or get medical help right away if you have any of the following signs or symptoms that may be related to a very bad side effect:
  • Signs of an allergic reaction, like rash; hives; itching; red, swollen, blistered, or peeling skin with or without fever; wheezing; tightness in the chest or throat; trouble breathing, swallowing, or talking; unusual hoarseness; or swelling of the mouth, face, lips, tongue, or throat.
  • Change in eyesight, eye pain, or very bad eye irritation.
  • Eye discharge.
What are some other side effects of this drug?
  • All drugs may cause side effects. However, many people have no side effects or only have minor side effects. Call your doctor or get medical help if any of these side effects or any other side effects bother you or do not go away:
  • Eye irritation.
  • These are not all of the side effects that may occur. If you have questions about side effects, call your doctor. Call your doctor for medical advice about side effects.
  • You may report side effects to your national health agency.
How is this drug best taken?
  • Use this drug as ordered by your doctor. Read all information given to you. Follow all instructions closely.
  • To gain the most benefit, do not miss doses.
  • Use as you have been told, even if your signs get better.
  • For the eye only.
  • Wash your hands before and after use.
  • Do not touch the container tip to the eye, lid, or other skin.
  • When using, tilt your head back.
  • Pull down lower eyelid of affected eye/eyes.
  • Put a thin film of ointment into the lower eye.
  • Close eye and roll eyeball around for 1 to 2 minutes.
What do I do if I miss a dose?
  • Use a missed dose as soon as you think about it.
  • If it is close to the time for your next dose, skip the missed dose and go back to your normal time.
  • Do not use 2 doses or extra doses.
How do I store and/or throw out this drug?
  • Store at room temperature.
  • Store in a dry place. Do not store in a bathroom.
  • Keep all drugs in a safe place. Keep all drugs out of the reach of children and pets.
  • Throw away unused or expired drugs. Do not flush down a toilet or pour down a drain unless you are told to do so. Check with your pharmacist if you have questions about the best way to throw out drugs. There may be drug take-back programs in your area.
General drug facts
  • If your symptoms or health problems do not get better or if they become worse, call your doctor.
  • Do not share your drugs with others and do not take anyone else’s drugs.
  • Keep a list of all your drugs (prescription, natural products, vitamins, OTC) with you. Give this list to your doctor.
  • Talk with the doctor before starting any new drug, including prescription or OTC, natural products, or vitamins.
  • Some drugs may have another patient information leaflet. If you have any questions about this drug, please talk with your doctor, nurse, pharmacist, or other health care provider.
  • If you think there has been an overdose, call your poison control center or get medical care right away. Be ready to tell or show what was taken, how much, and when it happened.
Bacitracin, Neomycin, and Polymyxin B (Ophthalmic) (Patient Education – Pediatric Medication)
You must carefully read the “Consumer Information Use and Disclaimer” below in order to understand and correctly use this information
Pronunciation

(bas i TRAY sin, nee oh MYE sin, & pol i MIKS in bee)

Brand Names: US

Neo-Polycin

What is this drug used for?
  • It is used to treat eye infections.
What do I need to tell the doctor BEFORE my child takes this drug?
  • If your child has an allergy to this drug or any part of this drug.
  • If your child is allergic to any drugs like this one or any other drugs, foods, or other substances. Tell the doctor about the allergy and what signs your child had, like rash; hives; itching; shortness of breath; wheezing; cough; swelling of face, lips, tongue, or throat; or any other signs.
  • If your child has a herpes, viral, or fungal infection of the eye.
  • This is not a list of all drugs or health problems that interact with this drug.
  • Tell the doctor and pharmacist about all of your child’s drugs (prescription or OTC, natural products, vitamins) and health problems. You must check to make sure that it is safe for your child to take this drug with all of his/her drugs and health problems. Do not start, stop, or change the dose of any drug your child takes without checking with the doctor.
What are some things I need to know or do while my child takes this drug?
  • Tell all of your child’s health care providers that your child is taking this drug. This includes your child’s doctors, nurses, pharmacists, and dentists.
  • Have your child avoid tasks or actions that call for alertness or clear eyesight until you see how this drug affects your child. These are things like riding a bike, playing sports, or using items such as scissors, lawnmowers, electric scooters, toy cars, or motorized vehicles.
  • Have your child stop wearing his/her contact lenses unless the doctor tells them to keep wearing them.
  • Do not give to your child longer than you have been told. A second infection may happen.
  • If your child is pregnant or breast-feeding a baby:
  • Talk with the doctor if your child is pregnant, becomes pregnant, or is breast-feeding a baby. You will need to talk about the benefits and risks to your child and the baby.
What are some side effects that I need to call my child’s doctor about right away?
  • WARNING/CAUTION: Even though it may be rare, some people may have very bad and sometimes deadly side effects when taking a drug. Tell your child’s doctor or get medical help right away if your child has any of the following signs or symptoms that may be related to a very bad side effect:
  • Signs of an allergic reaction, like rash; hives; itching; red, swollen, blistered, or peeling skin with or without fever; wheezing; tightness in the chest or throat; trouble breathing, swallowing, or talking; unusual hoarseness; or swelling of the mouth, face, lips, tongue, or throat.
  • Change in eyesight, eye pain, or very bad eye irritation.
  • Eye discharge.
What are some other side effects of this drug?
  • All drugs may cause side effects. However, many people have no side effects or only have minor side effects. Call your child’s doctor or get medical help if any of these side effects or any other side effects bother your child or do not go away:
  • Eye irritation.
  • These are not all of the side effects that may occur. If you have questions about side effects, call your child’s doctor. Call your child’s doctor for medical advice about side effects.
  • You may report side effects to your national health agency.
How is this drug best given?
  • Give this drug as ordered by your child’s doctor. Read all information given to you. Follow all instructions closely.
  • To gain the most benefit, do not miss giving your child doses.
  • Keep giving this drug to your child as you have been told by your child’s doctor or other health care provider, even if your child feels well.
  • For the eye only.
  • Wash your hands before and after use.
  • Do not touch the container tip to your child’s eye, lid, or other skin.
  • When using, tilt your child’s head back.
  • Gently pull down the lower lid and squeeze in how much the doctor told you to use.
  • Let go of the lower eyelid and have your child keep eyes closed for 1 to 2 minutes.
What do I do if my child misses a dose?
  • Give a missed dose as soon as you think about it.
  • If it is close to the time for your child’s next dose, skip the missed dose and go back to your child’s normal time.
  • Do not give 2 doses at the same time or extra doses.
How do I store and/or throw out this drug?
  • Store at room temperature.
  • Store in a dry place. Do not store in a bathroom.
  • Keep all drugs in a safe place. Keep all drugs out of the reach of children and pets.
  • Throw away unused or expired drugs. Do not flush down a toilet or pour down a drain unless you are told to do so. Check with your pharmacist if you have questions about the best way to throw out drugs. There may be drug take-back programs in your area.
General drug facts
  • If your child’s symptoms or health problems do not get better or if they become worse, call your child’s doctor.
  • Do not share your child’s drug with others and do not give anyone else’s drug to your child.
  • Keep a list of all your child’s drugs (prescription, natural products, vitamins, OTC) with you. Give this list to your child’s doctor.
  • Talk with your child’s doctor before giving your child any new drug, including prescription or OTC, natural products, or vitamins.
  • Some drugs may have another patient information leaflet. If you have any questions about this drug, please talk with your child’s doctor, nurse, pharmacist, or other health care provider.
  • If you think there has been an overdose, call your poison control center or get medical care right away. Be ready to tell or show what was taken, how much, and when it happened.