Bacitracin Zinc + Neomycin Sulphate + Polymixin B topical
Indications
Bacitracin Zinc + Neomycin Sulphate + Polymixin B topical is used for:
Minor cuts, Scrapes, Burns, Eczematoid dermatitis, Neurodermatitis, Eczema, Anogenital pruritus, Impetigo, Contact dermatitis, Bacterial skin infections.
Adult Dose
Treatment/Prophylaxis Superficial Skin Infection
Apply topically 3 times daily.
Child Dose
Treatment/Prophylaxis Superficial Skin Infection
Apply topically 3 times daily.
Renal Dose
Administration
Contra Indications
Hypersensitivity
Precautions
Allergic cross-reactions may occur which could prevent the use of any or all of the following antibiotics for the treatment of future infections: kanamycin, paromomycin, streptomycin, and possibly gentamicin.
Lactation: unknown if distributed in breast milk
Pregnancy-Lactation
Interactions
Bacitracin Zinc: Increased risk of nephrotoxicity when used with other nephrotoxic drugs. May enhance the action of neuromuscular-blocking agents.
Neomycin Sulphate: Additive nephrotoxic and neurotoxic effect w/ other aminoglycosides (e.g. paromomycin), bacitracin, cisplatin, vancomycin, amphotericin B, polymyxin B, colistin and viomycin. Enhanced toxicity w/ potent diuretics (e.g. ethacrynic acid, furosemide). May impair the absorption of other drugs (e.g. phenoxymethylpenicillin, digoxin, methotrexate and some vit). May reduce the efficacy of OCs. May enhance the effect of acarbose. May enhance the effect of non-depolarising muscle relaxants. May antagonise the parasympathomimetic effect of neostigmine and pyridostigmine. May increase the risk of hypocalcaemia in patients receiving bisphosphonates. May alter INR when given w/ anticoagulants. May inactivate oral typhoid vaccine.
Polymixin B: Potentially Fatal: Additive neurotoxic or nephrotoxic effect w/ bacitracin, streptomycin, neomycin, kanamycin, gentamicin, tobramycin, amikacin, cephaloridine, paromomycin, viomycin, colistin. Increased risk of resp paralysis w/ neuromuscular blockers (e.g. anaesthetics, muscle relaxants).
Adverse Effects
Side effects of Bacitracin Zinc + Neomycin Sulphate + Polymixin B topical :
>10%
Allergic contact dermatitis (60%)
Mechanism of Action
Neomycin, an aminoglyoside with antimicrobial spectrum similar to gentamicin, binds to the 30S subunits of the bacterial ribosome, inhibiting protein synthesis and thereby disrupting DNA synthesis. It is active against many gram-negative aerobes and against some strains of staphylococci.
Bacitracin, on the other hand, inhibits bacterial cell wall synthesis and is active against many gram-positive bacteria (e.g. staphylococci, streptococci, corynebacteria and clostridia) and some gram-negative species (e.g. Neisseria and Haemophilus influenzae). They are often found in combinations in topical preparations as broad spectrum antibacterial agents.
Polymyxin B disrupts the bacterial cytoplasmic membrane of mostly gm-ve organisms allowing leakage of intracellular constituents by binding to membrane phospholipids.