Neomycin is an aminoglycoside antibiotic.

Dosage and
Administration
Reconstitution and Administration Neomycin sulfate is
usually administered orally. In patients with hepatic
encephalopathy who are unable to take oral medication, the
drug has also been given as a retention enema.
Dosage While potency of neomycin sulfate has been
expressed both in terms of the base and the salt, dosage
generally has been expressed in terms of the sulfate. (See
Chemistry and Stability: Chemistry.) Dosages that follow are
in terms of neomycin sulfate.
Hepatic Encephalopathy
As an adjunct in the treatment of hepatic encephalopathy,
the usual adult oral dosage is 4-12 g of neomycin sulfate
daily in 4 divided doses for 5-6 days. Patients with chronic
hepatic insufficiency may require up to 4 g daily for an
indefinite period.
Preoperative Intestinal Antisepsis
For preoperative intestinal antisepsis in patients undergoing
colorectal surgery, oral neomycin sulfate is usually given for
24 hours, and treatment should not exceed 72 hours. A low
residue diet should be prescribed. A saline cathartic should
be administered (unless otherwise contraindicated)
immediately preceding initiation of neomycin sulfate therapy.
For the 24-hour regimen, the usual adult oral dosage of
neomycin sulfate is 1 g each hour for 4 doses, then 1 g
every 4 hours for the balance of the 24 hours. For the 2- to
3-day regimen, the usual daily dosage for adults and
children is 88 mg/kg in 6 equally divided doses at 4-hour
intervals. Alternatively, some clinicians recommend that if
surgery is scheduled for 8 a.m., 1 g of neomycin sulfate and
1 g of erythromycin base should be administered at 1 p.m., 2
p.m., and 11 p.m. on the day preceding surgery as an
adjunct to mechanical cleansing of the intestine.
Diarrhea Caused by Enteropathogenic E. coli For the
treatment of diarrhea caused by enteropathogenic E. coli,
the usual oral dosage is 50 mg/kg daily in 4 divided doses
for 2-3 days. In adults, a dosage of 3 g daily is usually
adequate.
Urinary Tract Infections Although most infectious disease
experts no longer recommend parenteral use of neomycin,
adults have been given 15 mg/kg daily administered in 4
equally divided IM doses every 6 hours in the treatment of
urinary tract infections caused by susceptible organisms.
However, a parenteral dosage form of the drug is no longer
commercially available in the U.S.
able in the U.S.
Other Uses
For the treatment of hypercholesterolemia in adults, oral
neomycin sulfate dosages of 500 mg to 2 g daily,
administered in 2 or 3 divided doses with or immediately
after meals, have been used. Dosage should not exceed 2 g
daily.
Dosage in Renal Impairment Patients with renal
impairment should receive reduced dosages of neomycin
sulfate.
Pharmacokinetics
Absorption Approximately 3% of an oral dose of
neomycin sulfate is absorbed from the normal GI tract;
however, impaired GI motility may increase absorption of the
drug. In a limited clinical study in adults, absorption of
neomycin from retention enemas was similar to that
following oral administration. In one study in adults with
normal renal function, a single 4-g oral dose of neomycin
sulfate produced peak plasma neomycin concentrations of
2.5-6.1 mcg/mL 1-4 hours after the dose in most patients;
low plasma concentrations of the drug were detectable at 8
hours and no drug was detectable at 24 hours. After IM
administration of 300 mg of neomycin sulfate every 6 hours
for 4 doses followed by 300 mg every 12 hours in adults,
serum neomycin concentrations range from 12-30 mcg/mL
48-72 hours after the initial dose.
Elimination The plasma elimination half-life of neomycin
is usually 2-3 hours in adults with normal
renal function and has been reported to be 12-24 hours in
adults with impaired renal function.
Following oral administration in adults, unabsorbed
neomycin is excreted unchanged in the feces and
approximately 1% of the dose is excreted in the urine by
glomerular filtration within 24 hours.
Chemistry and Stability Chemistry

neomycin B (framycetin)
Neomycin, an aminoglycoside antibiotic obtained from
cultures of Streptomyces fradiae, is a complex of 3
components with various degrees of antimicrobial activity
neamine, neomycin B, and neomycin C. The commercially
available drug is comprised almost entirely of the sulfate salt
of neomycin B and occurs as a white to slightly yellow,
hygroscopic powder or cryodesiccated solid and is freely
soluble in water and very slightly soluble in alcohol.
Neomycin sulfate oral solutions have a pH of 5-7.5. Although
USP states that potency of neomycin sulfate should be
expressed in terms of the base, potency and dosage
generally have been expressed in terms of the sulfate. Each
500 mg of neomycin sulfate is approximately equivalent to
350 mg of neomycin.
Stability Neomycin sulfate oral solution should be stored
in tight, light-resistant containers,
preferably at 15-30C. Neomycin sulfate tablets should be
stored in tight containers at 15-30C.
For further information on chemistry and stability,
mechanism of action, spectrum, resistance,
pharmacokinetics, uses, cautions, drug interactions, and
dosage and administration of neomycin, see the
Aminoglycosides General Statement 8:12.02. For topical
uses of neomycin, see Neomycin 52:04.04 and 84:04.04.
Preparations
Neomycin Sulfate

Powder
Oral Solution
Tablets
References

Neo-Rx Powder, Pharma- Tek

125 mg (87.5 mg of neomycin) Neo-Fradin, Pharma- per 5

mL Tek
500 mg (350 mg of neomycin)

200. Pharma-Tek Inc. Neo-IM (neomycin sulfate)

prescribing information. Huntington, NY. 1986 Feb.