Neomycin/polymyxin B/bacitracin

Neomycin/polymyxin B/bacitracin, also known as triple antibiotic ointment, is a medication used to try to decrease the risk of infections following minor skin injuries and to treat superficial bacterial eye infections.[2][3] It contains three antibiotics neomycin, polymyxin B, and bacitracin.[2] It is generally less preferred than bacitracin/polymyxin B.[4] It is either applied to the skin or used as eye drops.[2][3]

Neomycin/polymyxin B/bacitracin
A tube of Neosporin
Combination of
Polymyxin B sulfateAntibiotic
Neomycin sulfateAntibiotic
Bacitracin zincAntibiotic
Clinical data
Trade namesNeosporin, others
AHFS/Drugs.comMicromedex Detailed Consumer Information
License data
Pregnancy
category
    Routes of
    administration    		Topical, eye drops
    Legal status
    Legal status
    Identifiers
    ChemSpider
      (verify)

    Common side effects include itchiness and skin rash.[1] More severe side effects may include hearing loss.[1] Use in pregnancy is generally not recommended.[1] It is relatively broad spectrum, being effective against both Gram-negative and Gram-positive bacteria.[3]

    The combination was approved for medical use in the United States in 1971.[5] It is available over the counter in the United States.[1] In 2016 it was the 81st most prescribed medication in the United States with more than 9 million prescriptions.[6] It is sold under the brand name Neosporin among others.[7]

    Medical uses

    Neomycin/polymyxin B/bacitracin ointment is reported to be a safe and effective topical agent for preventing infections in minor skin trauma.[8] It, however, is generally less preferred than bacitracin/polymyxin B due to its greater side effects.[4]

    It is used for burns, scratches, cuts, and minor skin infections.[9] The ointment is most effective when applied after cleaning the affected area.

    The use of neomycin/polymyxin B/bacitracin, decreases infection rates in minor-contaminated wounds.[10] However, if the wound is sterile, then there are no benefits compared to petrolatum (placebo).[10][11]

    Side effects

    It is for external use only and should not be applied near mucous membranes such as the eyes or mouth. It is not recommended for children under the age of two. Users should immediately seek medical attention if they experience hives, rashes, or itching. Any skin irritations such as pain, burning, or cracked skin that were not present prior to use of ointment must receive immediate care.[12]

    Concern exists that its use contributes to the emergence of antibiotic-resistant bacteria. In the US, the only large market for the ointment may promote antibiotic resistance. For instance, it may increase the prevalence of MRSA bacteria,[13] specifically the highly lethal ST8:USA300 strain.[14][15][16]

    It has been shown to cause contact dermatitis in some cases.[17]

    Components

    The original ointment contains three different antibiotics: bacitracin, neomycin, and polymyxin B, in a relatively low-molecular-weight base of cocoa butter, cottonseed oil, sodium pyruvate, tocopheryl acetate, and petroleum jelly.

    The generic name for these products, regardless of the base, is "triple antibiotic ointment". In China, the product is named "complex polymyxin B ointment" and is manufactured there by Zhejiang Fondnow Pharmaceutical Co. Ltd. The product was also marketed by the Upjohn Company under the name "Mycitracin", until 1997 when that name was acquired by Johnson & Johnson.[18]

    Some people have allergic reactions to neomycin, so a "double antibiotic ointment" is sold without it, containing only bacitracin and polymyxin B: one such example is Polysporin branded product.

    A "Plus" variant of the ointment exists that adds the analgesic pramoxine, but uses the cheap, simple, long-lasting, but heavier petroleum jelly base, common to many over-the-counter topicals. The latest version of this analgesic formulation, a high-absorption cream, excludes bacitracin because it is unstable in such a base.

    Active ingredients

    The three main active ingredients in Neosporin are neomycin sulfate, polymyxin B sulfate, and bacitracin zinc.

    One of the main components is neomycin sulfate, which is a type of antibiotic discovered in 1949 by microbiologist Selman Waksman at Rutgers University.[19] Neomycin belongs to the aminoglycoside class of antibiotics and fights against Gram positive and gram negative bacteria. The antibiotic is often used to prevent risk of bacterial infections.[20] Aminoglycosides work by binding to bacterial RNA and changing the ability to produce proteins while exerting little to no effect on DNA. Thus, neomycin kills bacteria as a result of irregular protein production in the bacterial cell. When the cell can no longer produce the correct proteins, its membrane becomes damaged.[21] As a result of damaged membrane, the affected bacterial cells die, and the infection is prevented or limited.

    Like neomycin, polymyxin B is an antibiotic. Polymyxin B forms holes in the bacterial cell wall causing the internal cellular components to leak out, resulting in cell death. This antibiotic also interferes with the production of tetrahydrofolic acid by altering an enzyme. Without the tetrahydrofolic acid, the bacteria can no longer produce proteins necessary for survival.[22]

    Pramoxine is used to temporarily reduce pain from burns, insect bites, and minor cuts. It works like an anesthetic by decreasing the permeability of neuron membranes. As a result, pain neurons in the area have difficulty sending signals (or signals are blocked entirely), resulting in numbness.[23]

    In some countries, bacitracin is replaced with gramicidin.

    History

    Neosporin is the brand name for a product produced by Johnson & Johnson that contains neomycin sulfate, polymyxin B, and bacitracin. There is no exact date to when the antibacterial ointment was invented, but it was used as early as the 1950s. This antibiotic ointment was patented in the United States on August 27, 1951.[24]

    References
    1. "Neomycin, polymyxin b, and bacitracin Topical Advanced Patient Information". Drugs.com. Retrieved 19 April 2019.
    2. "DailyMed - neomycin, bacitracin, polymyxin b ointment". dailymed.nlm.nih.gov. Retrieved 19 April 2019.
    3. "Neomycin and polymyxin B sulfates and bacitracin zinc ophthalmic ointment" (PDF). FDA. Retrieved 19 April 2019.
    4. Woo, Teri Moser; Robinson, Marylou V. (2015). Pharmacotherapeutics For Advanced Practice Nurse Prescribers. F.A. Davis. p. 651. ISBN 9780803645813.
    5. "Drugs@FDA: FDA Approved Drug Products". www.accessdata.fda.gov. Retrieved 19 April 2019.
    6. "The Top 300 of 2019". clincalc.com. Retrieved 22 December 2018.
    7. "Neosporin (topical) Uses, Side Effects & Warnings". Drugs.com. Retrieved 19 April 2019.
    8. Bonomo, Robert A.; Zile, Peter S. Van; Li, Qing; Shermock, Kenneth M.; McCormick, William G.; Kohut, Bruce (2007-10-01). "Topical triple-antibiotic ointment as a novel therapeutic choice in wound management and infection prevention: a practical perspective". Expert Review of Anti-infective Therapy. 5 (5): 773–782. doi:10.1586/14787210.5.5.773. ISSN 1478-7210. PMID 17914912.
    9. "Neosporin (neo-bac-polym) topical : Uses, Side Effects, Interactions, Pictures, Warnings & Dosing - WebMD". WebMD. Retrieved 2015-12-03.
    10. Diehr, S; Hamp, A; Jamieson, B; Mendoza, M (February 2007). "Clinical inquiries. Do topical antibiotics improve wound healing?". The Journal of Family Practice. 56 (2): 140–4. PMID 17270122. The use of topical triple-antibiotic ointments significantly decreases infection rates in minor contaminated wounds compared with a petrolatum control. Plain petrolatum ointment is equivalent to triple-antibiotic ointments for sterile wounds as a post-procedure wound dressing (strength of recommendation [SOR]: A, based on randomized controlled trials [RCTs]).
    11. Draelos, ZD; Rizer, RL; Trookman, NS (2011). "A comparison of postprocedural wound care treatments: Do antibiotic-based ointments improve outcomes?". Journal of the American Academy of Dermatology. 64 (3 Suppl): S23–9. doi:10.1016/j.jaad.2010.11.010. PMID 21247662.
    12. "Neosporin Would Care FAQs". Neosporin. Retrieved 8 May 2015.
    13. Martin, David (14 September 2011). "MRSA in U.S. becoming resistant to over the counter ointment". CNN. Retrieved 2 June 2012.
    14. Suzuki, M; Yamada, K; Nagao, M; Aoki, E; Matsumoto, M; Hirayama, T; Yamamoto, H; Hiramatsu, R; Ichiyama, S; Iinuma, Yoshitsugu (2011). "Antimicrobial ointments and methicillin-resistant Staphylococcus aureus USA300". Emerging Infectious Diseases. 17 (10): 1917–20. doi:10.3201/eid1710.101365. PMC 3310646. PMID 22000371.
    15. Spann, CT; Taylor, SC; Weinberg, JM (2004). "Topical antimicrobial agents in dermatology". Disease-a-month : DM. 50 (7): 407–21. doi:10.1016/j.disamonth.2004.05.011. PMID 15280871.
    16. Trookman, NS; Rizer, RL; Weber, T (2011). "Treatment of minor wounds from dermatologic procedures: A comparison of three topical wound care ointments using a laser wound model". Journal of the American Academy of Dermatology. 64 (3 Suppl): S8–15. doi:10.1016/j.jaad.2010.11.011. PMID 21247665.
    17. Sheth, VM; Weitzul, S (2008). "Postoperative topical antimicrobial use". Dermatitis : Contact, Atopic, Occupational, Drug. 19 (4): 181–9. PMID 18674453.
    18. "McNeil Consumer Products Co. strengthens worldwide lead in OTC pain reliever market" (Press Release). Business Wire. Fort Washington, PA: Business Wire. June 5, 1997. Retrieved June 28, 2011
    19. "Neomycin Details". MedsChat.com. Retrieved 8 May 2015.
    20. "Neomycin Sulfate". RxList. Retrieved 8 May 2015.
    21. "Neomycin". Health24. Retrieved 8 May 2015.
    22. "polymyxin B sulfate and trimethoprim (Polytrim)". MedicineNet. Retrieved 8 May 2015.
    23. "Pramoxine". Medicine Plus. Retrieved 8 May 2015.
    24. "Tetracycline type antibiotic ointment". Google. Retrieved 8 May 2015.
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