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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.