Neomycin

Brand Names: Minims, Neo-Cortef

Clinical Names: Neomycin Sulfate

Summary

generic name: Neomycin

trade names: Ak-Spore® H.C., Bacticort®, Cobiron®, Cortisporin Ophthalmic Suspension, Cortomycin®, Hydromycin®, I-Neocort®, Minims®, Neo-Cortef®, Neosporin®, Ocutricin® HC, Triple-Gen®, LazerSporin-C®, Octiair®, Ortega Otic-M®, Otocort®, Otoreid-HC®, Pediotic®, Terramycin®

note: Neomycin may be found in topical antibiotic creams, lotions, ointments, eyedrops, and eardrops. It is often combined with hydrocortisone, dexamethasone, Polymyxin B and other antibacterial agents.

type of drug: Aminoglycoside antibiotic, antibacterial; most commonly in topical form.

mechanism: Neomycin is absorbed from the peritoneum, respiratory tract, bladder, wounds and inflamed skin; little is absorbed when applied topically. It interferes with bacterial protein synthesis by binding primarily to the 30S subunit of bacterial ribosomes. Neomycin sulphate is active against many strains of Gram-positive and Gram-negative bacteria including Staph. aureus, E. coli, Klebsiella spp., H. influenzae, S. typhi, Shigella and Mycobacterium tuberculosis.

used to treat: Allergic, atopic and seborrheic dermatitis, eye infections, hepatic coma, neurodermatitis, otitis media, pruritus ani and vulvae; combined with enteric coated erythromycin before surgery to avoid infection due to bacteria in the digestive tract.

overview of interactions:
• nutrient affected by drug: Multiple Nutrients, esp. Vitamins and Minerals

• nutrient affected by drug: Beta-Carotene and Vitamin A

• nutrient affected by drug: Vitamin B6

• nutrient affected by drug: Vitamin B12

• nutrient affected by drug: Vitamin K

• nutrient affected by drug: Calcium

• nutrient affected by drug: Magnesium

• nutrient affected by drug: Dietary Fat

• nutrient affected by drug: Lactose

• nutrient affected by drug: Sucrose

• adverse drug effects: Probiotic Intestinal Flora



Interactions

nutrient affected by drug: Multiple Nutrients, esp. Vitamins and Minerals

• mechanism: When taken orally neomycin may induce maldigestion and malabsorption by three mechanisms: inhibition of pancreatic enzymes, precipitation of bile salts, and mucosal damage.

• research: Neomycin impairs absorption (and may also increase excretion) of a broad variety of nutrients including carbohydrates, fats, calcium, iron, magnesium, nitrogen, potassium, sodium, folic acid, and vitamins A, B12, D, and K.
(Faloon WW, et al. Ann N Y Acad Sci. 1966 Jun 14;132(2):879-887; Hardison WG, Rosenberg IH.J Lab Clin Med. 1969 Oct;74(4):564-573; Robinson C, Weigly E. 1984, 46-54; Roe DA. 1985, 157-158.)

• nutritional support: One time oral administration of neomycin, e.g. in preparation for surgery, is unlikely to compromise general nutritional status in any significant way. Individuals taking neomycin internally for more than one week may benefit from taking a multivitamin/-mineral formulation. Individuals using neomycin topically will not experience problems related to malabsorption.

nutrient affected by drug: Beta-Carotene and Vitamin A

• research: Orally administered neomycin impairs absorption of both beta-carotene and vitamin A.
(Tuckerman M, Turco S. 1983, 215-222; Robinson C, Weigly E. 1984, 46-54; Barrowman JA, et al. Clin Sci. 1972 Apr;42(4):17P; Favaro RM, et al. Int J Vitam Nutr Res. 1994;64(2):98-103.)

• nutritional support: Individuals taking neomycin internally for more than 2-3 days may benefit from taking supplemental beta-carotene at doses of 25,000 IU (15 mg) per day. Individuals using neomycin topically will not experience problems related to decreased absorption.

nutrient affected by drug: Vitamin B6

• mechanism: Orally administered neomycin may inactivate vitamin B6.

• nutritional support: Individuals taking neomycin orally for more than 2-3 days may benefit from taking supplemental vitamin B6 at doses of 25-50 mg per day. Individuals using neomycin topically will not experience problems related to inactivation of vitamin B6.

nutrient affected by drug: Vitamin B12

• research: Orally administered neomycin impairs vitamin B12 absorption and has been shown to decrease vitamin B12 levels.
(Tuckerman M, Turco S. 1983, 215-222; Robinson C, Weigly E. 1984, 46-54; Cullen RW, Oace SM. J Nutr. 1989 Oct;119(10):1399-1403..)

• nutritional support: Individuals taking neomycin internally for more than 2-3 days may benefit from taking supplemental vitamin B12 at doses of 10-25 mcg per day. Such supplementation may be more important for the elderly since they tend to have lower B12 levels due to decline in digestive efficiency. Individuals using neomycin topically will not experience problems related to decreased levels of vitamin B12..

nutrient affected by drug: Vitamin K

• research: Neomycin, taken orally, impairs vitamin K absorption and has been shown to decrease vitamin K levels. Extended use of neomycin internally would also exert a detrimental effect upon the probiotic intestinal flora responsible for vitamin K synthesis.
(Robinson C, Weigly E. 1984, 46-54; Olson JA. Am J Clin Nutr. 1987 Apr;45(4):687-692; Salet J, et al. Arch Fr Pediatr. 1968 Oct;25(8):961.)

• nutritional support: Individuals taking neomycin internally for more than 2-3 days may benefit from taking supplemental vitamin K at doses of 65-80 mg per day. Such supplementation would be especially important for nursing infants; consult the prescribing physician in such situations for a recommended dose. Individuals using neomycin topically will not experience problems related to impaired absorption of vitamin K.

nutrient affected by drug: Calcium

• mechanism: Neomycin impairs calcium absorption when taken orally.
(Roe DA. 1985, 157-158.)

• nutritional support: Individuals taking neomycin internally for more than 2-3 days may benefit from taking supplemental calcium at doses of 500-800 mg per day.

nutrient affected by drug: Magnesium

• mechanism: Neomycin impairs magnesium absorption as a result of maldigestion when taken orally.
(Roe DA. 1985, 157-158.)

• nutritional support: Individuals taking neomycin internally for more than 2-3 days may benefit from taking supplemental magnesium at doses of 250-400 mg per day.

nutrient affected by drug: Dietary Fat

• mechanism: Neomycin causes fat malabsorption when taken internally, especially due to mucosal damage in the small intestine. Diarrhea is a common consequence. Further, over an extended period this effect could also result in decreased absorption of fat soluble nutrients such as vitamins A, D, E and K.
(Hardison WG, Rosenberg IH. J Lab Clin Med. 1969 Oct;74(4):564-573; Roe DA. 1985, 157-158; Ratnaike RN, Jones TE. Drugs Aging 1998 Sep;13(3):245-253.)

• nutritional support: Individuals taking neomycin orally for more than one week may benefit from taking a multivitamin formulation.

nutrient affected by drug: Lactose

• mechanism: Neomycin impairs lactose absorption when taken orally.
(Roe DA. 1985, 157-158.)

nutrient affected by drug: Sucrose

• mechanism: Neomycin impairs sucrose absorption when taken orally.
(Roe DA. 1985, 157-158.)

adverse drug effects: Probiotic Intestinal Flora

• mechanism: During the course of eliminating disease-causing bacteria, antibiotics taken internally will also usually destroy normally-occurring beneficial bacterial flora that form an integral part of the healthy intestinal ecology and assist digestive and immune functions. Diarrhea and yeast infections, including vaginal yeast, are common side-effects of the disruption of intestinal ecology and the creation of an environment more susceptible to proliferation of pathogenic levels of opportunistic yeast.
(Matteuzzi D, et al. Ann Microbiol (Paris). 1983 May-Jun;134A(3):339-349; Linzenmeier G, et al. Zentralbl Bakteriol . 1979 Apr;243(2-3):326-335.)

• nutritional support: If neomycin is used internally for more than a single dose, supplementation of beneficial "probiotic" bacterial flora, such as Lactobacillus acidophilus, Bifidobacterium bifidus and Lactobacillus cassei, preferably in the form of a varied, vigorous and abundant culture, will probably support the healthy intestinal ecology and stabilize the mucosal lining of the gut. A supplemental dosage of at least one billion organisms per day is necessary to achieve the critical mass of bacterial restoration and successfully reinvigorate healthy intestinal ecology.

Note: Further information on the interactions between antibiotics and Probiotic intestinal flora can be found within the topics: Antibiotics and/or Probiotic Bacterial Flora.

Please read the disclaimer concerning the intent and limitations of the information provided here.
Do not rely solely on the information in this article.

The information presented in Interactions is for informational and educational purposes only. It is based on scientific studies (human, animal, or in vitro), clinical experience, case reports, and/or traditional usage with sources as cited in each topic. The results reported may not necessarily occur in all individuals and different individuals with the same medical conditions with the same symptoms will often require differing treatments. For many of the conditions discussed, treatment with conventional medical therapies, including prescription drugs or over-the-counter medications, is also available. Consult your physician, an appropriately trained healthcare practitioner, and/or pharmacist for any health concern or medical problem before using any herbal products or nutritional supplements or before making any changes in prescribed medications and/or before attempting to independently treat a medical condition using supplements, herbs, remedies, or other forms of self-care.


References

Barrowman JA, Broomhall J, Cannon AM, Christmas S, D'Mello A, Herxheimer A, Pring DW, Robson TW, Woolf AD. Impairment of vitamin A absorption by neomycin. Clin Sci. 1972 Apr;42(4):17P.

Cullen RW, Oace SM.  Neomycin has no persistent sparing effect on vitamin B-12 status in pectin-fed rats. J Nutr. 1989 Oct;119(10):1399-1403.

Abstract: In the present study, rats were depleted of vitamin B-12 with fiber-free or 5% pectin diets, with or without neomycin. Through use of this intestinal antibiotic reported to "spare" vitamin B-12, we sought to determine if bacterial fermentation of pectin might explain our previous observations of negative effects of pectin on vitamin B-12 status. However, neomycin did not lessen interference by pectin with vitamin B-12 metabolism. Pectin increased urinary methylmalonate and decreased propionate oxidation to a greater extent in the presence than in the absence of neomycin. Also, regardless of the presence of neomycin, the biologic half-life of injected [57Co]vitamin B-12 was 58 d for rats fed the fiber-free diets and only 38 d for rats fed 5% pectin diets. Neomycin delayed early fecal excretion of 57Co but had no persistent effect. Thus, neomycin-sensitive bacteria do not mediate the negative effects of pectin on vitamin B-12 status. Pectin may interfere directly with vitamin B-12 absorption or may stimulate vitamin B-12 uptake or propionate production by microbial species that have adapted to neomycin.

Faloon WW, Paes IC, Woolfolk D, Nankin H, Wallace K, Haro EN. Effect of neomycin and kanamycin upon intestinal absorption. Ann N Y Acad Sci. 1966 Jun 14;132(2):879-887.

Faloon WW. Metabolic effects of nonabsorbable antibacterial agents. Am J Clin Nutr. 1970 May;23(5):645-651.

Favaro RM, Silva HC, Vannucchi H. Bioavailability of vitamin A in the rat following ingestion of neomycin sulfate or aluminium hydroxide. Int J Vitam Nutr Res. 1994;64(2):98-103.
Abstract: The objective of the present paper was to study the interaction of Neomycin and aluminium hydroxide with vitamin A in terms of the effect of these drugs on the bioavailability of vitamin A in the rat. Bioavailability was determined on the basis of the effects of the drugs on growth and on the plasma and hepatic levels of the vitamin. Vitamin A deficient animals were used in assay 1 and normal animals in assay 2. In each assay the animals were divided into 3 groups: one received Neomycin sulfate (0.1% in the diet), the second received aluminium hydroxide (0.05% in the diet) and the third (control) received no drug. Each of these three groups was subdivided into two groups receiving two different concentrations of vitamin A palmitate. The bioavailability of vitamin A was estimated by the parallel line method from the concentration of vitamin A in the diet and in the liver of the animals. No significant differences in growth or plasma retinol levels were observed between the groups of animals studied in assays 1 and 2. Total vitamin A concentration in the liver of the animals which received Neomycin was lower (p < 0.05) than that observed in the controls. Neomycin reduced the bioavailability of vitamin A by 13.9% (maximum, 18.1% and minimum, 9.6%) in assay 1 and by 13.5% (maximum, 17.7% and minimum, 9.3%) in assay 2. Aluminium hydroxide at the level tested did not affect the bioavailability of vitamin A.

Hardison WG, Rosenberg IH.  The effect of neomycin on bile salt metabolism and fat digestion in man. J Lab Clin Med. 1969 Oct;74(4):564-573.

Hill FW. An investigation of the effects of oral neomycin on intestinal absorption and serum cholesterol levels in the dog. Br Vet J. 1973 Jul-Aug;129(4):337-44.

Holt GA. Food and Drug Interactions. Chicago: Precept Press, 1998, 183-184.

Kendall MJ, Chan K. Drug-induced malabsorption. Xenobiotica 1973 Nov;3(11):727-744. (Review)

Korolkiewicz Z, Pocwiardowska-Ciara E. Effect of ascorbic acid in the presence of neomycin on isolated rat stomach strips. Acta Physiol Pol. 1986 Jul-Aug;37(4-5):177-182.
Abstract: The effects of vitamin C and acetylcholine on the smooth muscle of rat stomach were compared after neomycin-induced blockade of phosphatidylinositol metabolism. The cumulative curves of dose-dependent responses showed a non-competitive antagonism between vitamin C and neomycin. On the other hand, the antagonism between acetylcholine and neomycin was of a mixed, competitive-non-competitive type. The results of the experiments suggest the conclusion that a normal metabolism of phosphatidylinositol controlling calcium transport into the cells is necessary for the stimulating effect of vitamin C on the contractions of the smooth muscles in the digestive tract.

Lim KS, Huh CS, Baek YJ. Antimicrobial susceptibility of bifidobacteria. J Dairy Sci. 1993 Aug;76(8):2168-2174.
Abstract: The antimicrobial susceptibility of 37 strains of bifidobacteria to 18 antimicrobial agents was determined by a macrodilution broth method. Most of the strains used were isolated from commercial yogurts and starters. Tested organisms were usually sensitive to Gram-positive spectrum antibiotics (bacitracin, erythromycin, lincomycin, and vancomycin), and most of the organisms were inhibited by a concentration < 1.56 micrograms/ml. Erythromycin was the most active agent; all strains were inhibited by < .19 microgram/ml. beta-Lactam antibiotics (penicillin G, ampicillin, methicillin, and cephalothin), showing a wide range of minimum inhibitory concentration, were less effective than Gram-positive spectrum antibiotics. Most strains were somewhat resistant to cephalothin, exhibiting inhibition at concentrations of 6.25 to 25.0 micrograms/ml. Test organisms were most resistant to kanamycin, neomycin, paromomycin sulfate, nalidixic acid, and polymyxin B sulfate; inhibition occurred only at > or = 50 micrograms/ml, and strains were somewhat less resistant to gentamicin and streptomycin. Susceptibility to nitrofurantoin and tetracycline was variable; minimum inhibitory concentrations ranged from 1.56 to 50.0 and .39 to 50.0 micrograms/ml, respectively, but chloramphenicol had a narrow range from 1.56 to 6.25 micrograms/ml.

Linzenmeier G, Haralambie E, Dermoumi H. [Short-term oral chemoprophylaxis before intestine surgery. Quantitative determination of bacteria and fungi in stool specimens]. Zentralbl Bakteriol [Orig A] 1979 Apr;243(2-3):326-335. [Article in German]
Abstract: The methods of quantitative analysis of aerobe and anaerobe microbes and fungi stool specimens are described. The results of the studies in health people are compared to the results in patients undergoing surgical treatment of intestinal tract. A group of these patients received Neomycin and Bacitracin orally as short-time chemoprophylaxis to diminish possible woundinfection and/or sepsis. After oral medication germs as Bifidobacterium, Bacteroides and Clostridium (not Cl. perfringens) are reduced or lost, Veillonella, Eubacterium, Fusiformis, Peptostreptococcus and Lactobacillus were suppressed. Resistant strains of E. coli and Enterococci increased to high concentration/g faeces. After treatment the rate of gram-negative bacteria resistant to Neomycin increased. This might be of epidemiologically importance for the distribution of microbes resistant to Neomycin and other aminoglycosides as Klebsiella, Candida spec. and Torulopsis.

Matteuzzi D, Crociani F, Brigidi P. Antimicrobial susceptibility of Bifidobacterium. Ann Microbiol (Paris). 1983 May-Jun;134A(3):339-349.
Abstract: The susceptibility pattern of 459 strains of bifidobacteria, representing 15 species, to 16 antimicrobial agents was determined by the broth dilution method. The majority of the strains derived from human faeces. Penicillin G, erythromycin, clindamycin, vancomycin and bacitracin were the most active compounds; they inhibited 90% of the strains at less than 1.6 micrograms/ml. All strains were susceptible to chloramphenicol (MIC90 = 2.0-5.8 micrograms/ml) and also to lincomycin (MIC50 = 0.64-1.5 micrograms/ml). Neomycin, streptomycin and tetracycline presented a great variability in their activity. Most strains were resistant to polymyxin B, nalidixic acid, kanamycin, gentamicin and metronidazole. The only variation in susceptibility which was observed among the different species concerned Bifidobacterium suis, which generally appeared to be more resistant than other species.

Mayer J. Iatrogenic malnutrition. Postgrad Med. 1971 Mar;49(3):247-249.

Olson JA. Recommended dietary intakes (RDI) of vitamin K in humans. Am J Clin Nutr. 1987 Apr;45(4):687-692.

Proskuriakova MG. [Effect of different food substances on the absorption of neomycin from the gastrointestinal tract in experimental animals]. Antibiotiki. 1970 Nov;15(11):1019-1021. [Article in Russian]

Race TF, Paes IC, Faloon WW. Intestinal malabsorption induced by oral colchicine. Comparison with neomycin and cathartic agents. Am J Med Sci. 1970 Jan;259(1):32-41.

Ratnaike RN, Jones TE. Mechanisms of drug-induced diarrhoea in the elderly. Drugs Aging 1998 Sep;13(3):245-253.

Robinson C, Weigly E. Basic Nutrition and Diet Therapy. New York: MacMillan, 1984.

Roe DA. Diet and Drug Interactions. New York: Van Nostrand Reinhold, 1989.

Roe DA. Drug-induced Nutritional Deficiencies. 2nd ed. Westport, CT: Avi Publishing, 1985, 157-158.

Roe DA, Campbell T, eds. Drugs and Nutrients: The Interactive Effects. New York: Marcel Decker, 1984.

Salet J, Pean G, Hansel S, Baudon JJ. [Acute avitaminosis K in infants associated with diarrhea treated by antibiotics]. Arch Fr Pediatr. 1968 Oct;25(8):961. [Article in French]

Tuckerman M, Turco S. Human Nutrition. Philadelphia: Lea and Febiger, 1983, 215-222.