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What is Neomycin and What is it For?
Updated on June 26, 2023
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What is Neomycin and What is it For?

Neomycin is an antibiotic used to treat hepatic coma (a form of coma caused by liver failure) and to prevent bacterial infections before or after surgery. 

It is a broad-spectrum aminoglycoside antibiotic, a type of drug that inhibits bacteria's ability to replicate by disrupting bacterial protein synthesis. It usually comes in the form of a Neomycin sulfate tablet.

“Neomycin targets mostly gram-negative bacteria, bacteria which are ammonia-forming and are mostly concentrated in the gastrointestinal tract,” says our in-house expert, Dr. Rizza Mira.

How Does Neomycin Work in the Body?

Neomycin binds to the prokaryotic small ribosomal subunit, a part of cells that facilitates the translation of proteins which leads to cell multiplication. Neomycin interrupts this process, resulting in a bactericidal effect by inhibiting the bacteria’s ability to replicate.1

In particular, Neomycin decreases ammonia-producing bacteria found in the gastrointestinal tract. This is how it prevents hepatic coma, which is caused by elevated ammonia levels in the blood that would otherwise have been filtered by a healthy liver.

Neomycin is also poorly absorbed by the gastrointestinal tract, which is why it is an antibiotic of choice for preparing the bowels for surgery by preventing bacterial infection. Because of this, it retains its strength in the gut, making it more effective in killing gut bacteria. 

Doctors usually don’t want the antibiotic to circulate throughout the patient's whole body and disrupt the body’s natural, healthy intestinal bacteria.

Neomycin, like other aminoglycosides, is also effective against gram-negative bacteria by causing fissures in their usually impenetrable cell walls, effectively killing them.2 

Common infections caused by gram-negative organisms include:

  • Pneumonia
  • Meningitis
  • Bloodstream infections
  • Wound or surgical site infections

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When is Neomycin Prescribed?

Neomycin is a prescription-only medicine given to anyone suffering from bacterial infections or to prevent infections that may arise from bowel surgery. It is also used to treat hepatic coma.

Neomycin can be prescribed for oral administration as a Neomycin sulfate tablet or applied topically as an ointment for skin infections. They are also used topically as ear drops for ear infections.There are currently no recommendations against the use of Neomycin with pregnant women.

  • As a bactericidal agent, Neomycin is prescribed for bacterial infections and is ineffective against fungal or viral infections
  • Neomycin is primarily excreted in the kidneys. Caution is exercised in those with renal function abnormalities.5 Prolonged therapy using Neomycin is uncommon.
  • Also, because of its toxicity, Neomycin is not typically used for system-wide infections or prolonged treatment. Its most common uses include treating hepatic coma, preparing the bowel for surgery, or eye, ear, and rectal infections.

Neomycin also has some negative drug interactions with anticoagulants, anticonvulsants, and patients with a medical history of hypersensitivity.15

What Are the Potential Side Effects and Adverse Effects of Neomycin?

Neomycin has higher toxicity compared to other aminoglycosides and prescription drugs, which pose hazardous side effects such as nephrotoxicity (risk of kidney damage) and ototoxicity (risk of damage to the inner ear)

“Neomycin dosage needs to be adjusted for anyone with kidney problems,” says Dr. Mira.

Apart from these most serious side effects, other side effects include:6

  • Soreness of the mouth or rectal area
  • Nausea or vomiting
  • Clumsiness
  • Diarrhea
  • Difficulty breathing
  • Dizziness
  • Drowsiness
  • Greatly decreased frequency of urination
  • Increased amount of gas
  • Increased thirst
  • Light-colored, frothy, fatty-appearing stools
  • Hearing problems
  • Ringing or buzzing or a feeling of fullness in the ears
  • Skin rash
  • Unsteadiness
  • Weakness

Call your doctor if any of these adverse effects occur over a prolonged period of time. There is a greater risk of these side effects in elderly patients.

The Most Serious Toxic Effect of Neomycin

In extreme cases, Neomycin can cause severe kidney damage or even permanent hearing loss.7

The risk of nephrotoxicity and ototoxicity means that dosages in Neomycin therapy must be kept conservative and under the careful supervision of a healthcare professional. High doses increase the risk of toxic reactions. 

“If the drug is not discontinued, the damage is permanent,” says Dr. Mira.

Neomycin is used in preoperative bowel prep to avoid bacterial infections specifically because aminoglycosides are poorly absorbed by the digestive tract, but complications that require medical attention can still occur.

There have been cases of systemic absorption of Neomycin when used in an irrigant solution, such as when sterilizing bowels or irrigating large open wounds. In these cases, Neomycin use resulted in reversible kidney damage but permanent hearing loss.8

It is important to tell your doctor if you have any allergic reactions to Neomycin or other antibiotics during your treatment period as well.

Is Neomycin a Steroid or Penicillin?

Neomycin is not a steroid. Antibiotics work by killing or inhibiting the spread of bacteria. Steroids, on the other hand, are instead used to treat inflammatory conditions. 

Antibiotics and steroids may be prescribed together to speed up the healing process, as one reduces the actual bacterial infection while the other regulates the body’s response to the infection. 

Neomycin is also not the same as penicillin. While Neomycin is in the aminoglycoside class of antibiotics, penicillin belongs to the beta-lactam group. Beta-lactam antibiotics work by destroying the cell wall of bacteria, while aminoglycosides inhibit bacterial protein synthesis.

Alternatives to Neomycin for Bacterial Infections

For preoperative treatment, oral Neomycin is used to decrease the risk of infection in colorectal surgery but may be substituted by Fluoroquinolone if oral Neomycin is not available or has been identified as a potential risk to the patient.10

Fluoroquinolones are broad-spectrum antibiotics typically used to treat bacterial infections in the urinary tract, pneumonia, gastroenteritis, and gonococcal infections.

Erythromycin-metronidazole has also proven effective as a preoperative antibiotic versus Neomycin. The anaerobic bacteria responsible for most colon infections are already targeted by Erythromycin-metronidazole.11

Common antibiotics such as Metronidazole and Gentamicin also treat several of the same infections as Neomycin. Gentamicin is also an aminoglycoside. The two, however, affect the whole body versus Neomycin, which typically only affects the intestinal tracts (depending on how it’s administered). 

For hepatic coma, the laxative lactulose is often the first-line medicine used, while Rifaximin may replace Neomycin as the antibiotic component.

The advantages and disadvantages of using other medications and prescription drugs should be determined by your healthcare professional.

Neomycin in Combination with Other Drugs

Neomycin remains a common and top-of-mind antibiotic for doctors in many cases. A healthcare professional crafting treatment plans that incorporate Neomycin already considers risks and prescribe safe doses or combinations with other drugs with no drug interactions with Neomycin.

Neomycin, Polymyxin B, and Dexamethasone can be combined to treat certain eye infections and prevent other damage to the eye.13 In this combination, Neomycin and Polymyxin B are antibiotics that inhibit bacteria, while Dexamethasone is a steroid that relieves swelling in the eye. 

“The safety of these treatments still depends on the disease condition,” says Dr. Mira.

For skin infections, Neomycin is combined with Polymyxin and Bacitracin as a preventive ointment.14 While this is available without a prescription, use of this should still follow medical directions from a health professional. The ointment cannot be ingested and must be kept away from the eyes, nose, or mouth, and should not be used for deep or large wounds.

Neomycin sulfate is generally safe to take with dietary supplements but may affect the absorption of many nutrients.

Tell your doctor or health care professional if you have any allergic reactions to other medicines or concerns about side effects.

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Updated on June 26, 2023
Dr. Rizza Mira
Dr. Rizza Mira
Medical Reviewer
Dr. Rizza Mira is a medical doctor and a general practitioner who specializes in pediatrics, nutrition, dietetics, and public health.

As a pediatrician, she is dedicated to the general health and well-being of children and expecting parents. She believes that good nutrition, a healthy lifestyle, and prevention of illness are key to ensuring the health of children and their families.

When she’s not in the hospital, Rizza advocates and mobilizes causes like breastfeeding, vaccination drives, and initiatives to prevent illness in the community.
Will Hunter
Will Hunter
Content Contributor
Will is a content writer for KnowYourDNA. He received his B.A. in Psychology from the University of California, Los Angeles. Will has 7 years of experience writing health-related content, with an emphasis on nutrition, alternative medicine, and longevity.
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