Neomycin Sulphate 0.5% + Prednisolone 0.5% E/E prep
Indications
Neomycin Sulphate 0.5% + Prednisolone 0.5% E/E prep is used for:
Bacterial ocular infection, otitis externa
Adult Dose
Ophthalmic
Instill 1 or 2 drops every 3 or 4 hours, or more frequently as required.
Acute infections may require administration every 30 minutes, with frequency of administration reduced as the infection is brought under control.
Aural
Instill 1 or 2 drops 3-4 times daily or more frequently as required.
Child Dose
Renal Dose
Administration
Contra Indications
Epithelial herpes simplex keratitis (dendritic keratitis), vaccinia, varicella, and many other viral diseases of the cornea and conjunctiva. Mycobacterial infection of the eye. Fungal diseases of the ocular structures. Hypersensitivity to a component of the medication. (Hypersensitivity to the antibiotic component occurs at a higher rate than for other components.)
The use of these combinations is always contraindicated after uncomplicated removal of a corneal foreign body.
Precautions
The possibility of persistent fungal infections of the cornea should be considered after prolonged steroid dosing.
Prolonged use may result in overgrowth of nonsusceptible organisms, including fungi. If superinfection occurs, appropriate therapy should be initiated.
If purulent discharge, inflammation, or pain becomes aggravated, the patient should discontinue use of the medicatioin and consult a physician.
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.
Pregnancy-Lactation
Interactions
Synergistic effects with penicillins. Additive toxicity with neurotoxic, ototoxic or nephrotoxic drugs. May decrease absorption of digoxin and methotrexate. May increase effects of oral anticoagulants.
Adverse Effects
Side effects of Neomycin Sulphate 0.5% + Prednisolone 0.5% E/E prep :
Allergic sensitizations including itching, swelling, and conjunctival erythema . More serious hypersensitivity reactions, including anaphylaxis, have been reported rarely. The reactions due to the steroid component in decreasing order of frequency are: elevation of intraocular pressure (IOP) with possible development of glaucoma, and infrequent optic nerve damage; posterior subcapsular cataract formation; and delayed wound healing.
Although systemic effects are extremely uncommon, there have been rare occurences of systemic hypercorticoidism after use of topical steroids.
Corticosteroid-containing preparations have also been reported to cause perforation of the globe. Keratitis, conjunctivitis, corneal ulcers, and conjunctival hyperemia have occasionally been reported following local use of steroids.
Secondary infection: The development of secondary infection has occurred after use of combinations containing steroids and antimicrobials. Fungal infections of the cornea are particularly prone to develop coincidentally with long-term applications of steroids. The possibility of fungal invasion must be considered in any persistent corneal ulceration where steroid treatment has been used.
Secondary bacterial ocular infection following suppression of host responses also occurs.
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.
Prednisolone decreases inflammation by inhibition of migration of polymorphonuclear leukocytes and reversal of increased capillary permeability. It suppresses the immune system by reducing the activity and production of the lymphocytes and eosinophils.