The Hip: Preservation, Replacement and Revision

Neomycin Sulfate


- Neomycin alone and a mixture of Bacitracin and polymxin should be effective against all strains except proteus;
  - Evidence shows that 0.5% Neomycin solution irrigation may not decrease  infection, however, gentle scrubbing with this solution will dramatically decrease infections; (0.1% concentration is too weak);
  - the side effects of these topical ATB are minimal in the literature;
  - some researchers argue for a 1% to 5% Neomycin concentration;
      - at 5% all Proteus are killed
      - at 1% some Streptococci may not be killed;
- note some will avoid using Neomycin in large wounds requiring lengthy closure, because of the potential for systemic absorption;
  - there is evidence to suggest that the more an irrigant is used, the more effective it is in preventing infection;
    Infectious diarrhea w/ E. coli; hepatic coma: preop bowel prep;;Adult:3-12gm/24hr PO in 3-4 divided doses;
     Note: Neomycin will decrease of the PO absorption of Digoxin
- Neosporin G.U.Irrigant:
    - is also a combination of two antibiotics--Polymyxin B sulfate and Neomycin sulfate commonly used in urinary bladder irrigation;
    - these agents are combined in 1 L of saline to make final concentrations of Polymyxin B sulfate (200 U/mL) and Neomycin sulfate (40 mcg/mL);
    - although it is not recommended for use on open wounds, it continues to be used this way;
    - because this combination showed no toxicity in previous studies, the highest test dose was ten times the clinical dose.


A Randomized Prospective Study of Topical Antimicrobial Agents on skin Grafts After Thermal Injury.



Original Text by Clifford R. Wheeless, III, MD.

Last updated by Data Trace Staff on Thursday, December 6, 2012 4:06 pm