Neomycin/polymyxin B/bacitracin

Neomycin/polymyxin B/bacitracin, also known as triple antibiotic ointment, is a medication used to reduce the risk of infections following minor skin injuries.[1][2] It contains three antibiotics: neomycin, polymyxin B, and bacitracin.[1] It is for topical use only and should not be ingested due to risk of kidney damage.[3]

Neomycin/polymyxin B/bacitracin
Combination of
Polymyxin B sulfateAntibiotic
Neomycin sulfateAntibiotic
Bacitracin zincAntibiotic
Clinical data
Trade namesGeneric, Globe, Neosporin, others
AHFS/Drugs.comProfessional Drug Facts
MedlinePlusa601098
Routes of
administration		Topical, eye drops
Legal status
Legal status
  • US: OTC / Rx-only
Identifiers
CAS Number
ChemSpider
KEGG
  (verify)

Possible side effects include itchiness and skin rash,[4] and in rare cases hearing loss.[4] Use in pregnancy is generally recommended.[4] It is relatively broad spectrum, being effective against both Gram-negative and Gram-positive bacteria.[2]

The combination was approved for medical use in the United States in 1971.[5] It is available over the counter in the United States.[4] In 2017, it was the 78th most commonly prescribed medication in the United States, with more than ten million prescriptions.[6][7] It is sold under the brand name Globe and Neosporin, among others and is available generically at most major pharmaceutical retailers.[8]

Medical uses

Neomycin/polymyxin B/bacitracin ointment is reported to be a safe and effective topical agent for preventing infections in minor skin trauma.[9]

It is used for burns, scratches, cuts, and minor skin infections.[10] 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.[11] However, if the wound is sterile, then there are no benefits compared to petrolatum (placebo).[11][12]

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.[13]

It has been shown to cause contact dermatitis in some cases.[14]

Antibiotic-resistant bacteria

Concern exists that its use contributes to the emergence of antibiotic-resistant bacteria. In the US, the only large market for the ointment, it may increase antibiotic resistance. For instance, it may increase the prevalence of methicillin-resistant Staphylococcus aureus (MRSA) bacteria,[15] specifically the highly lethal ST8:USA300 strain.[16][17][18]

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 "compound polymyxin B ointment" and is manufactured there by Zhejiang Fonow Medicine 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.[19]

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 Neomycin are neomycin sulfate, polymyxin B sulfate, and bacitracin zinc.[8][10]

One of the main components is neomycin sulfate, which is a type of antibiotic discovered in 1949 by microbiologist Selman Waksman at Rutgers University.[20] 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.[21] 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.[22] 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.

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.[24]

History

There is no exact date as 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.[25]

References
  1. "DailyMed - neomycin, bacitracin, polymyxin b ointment". dailymed.nlm.nih.gov. Retrieved 19 April 2019.
  2. "Neomycin and polymyxin B sulfates and bacitracin zinc ophthalmic ointment" (PDF). U.S. Food and Drug Administration (FDA). Retrieved 19 April 2019.
  3. Zintel, H. A.; Ma, R. A.; Nichols, Anna C.; Ellis, Helen (1949). "The Absorption, Distribution, Excretion and Toxicity of Bacitracin in Man". American Journal of the Medical Sciences. 218 (4): 439–445. doi:10.1097/00000441-194910000-00012. PMID 18140540. S2CID 2371497.
  4. "Neomycin, polymyxin b, and bacitracin Topical Advanced Patient Information". Drugs.com. Retrieved 19 April 2019.
  5. "Drugs@FDA: FDA Approved Drug Products". U.S. Food and Drug Administration (FDA). Retrieved 19 April 2019.
  6. "The Top 300 of 2020". ClinCalc. Retrieved 11 April 2020.
  7. "Bacitracin; Neomycin; Polymyxin B - Drug Usage Statistics". ClinCalc. Retrieved 11 April 2020.
  8. "Neosporin (topical) Uses, Side Effects & Warnings". Drugs.com. Retrieved 19 April 2019.
  9. Bonomo RA, Van Zile PS, Li Q, Shermock KM, McCormick WG, Kohut B (October 2007). "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): 773–82. doi:10.1586/14787210.5.5.773. PMID 17914912. S2CID 31594289.
  10. "Neosporin (neo-bac-polym) topical : Uses, Side Effects, Interactions, Pictures, Warnings & Dosing - WebMD". WebMD. Retrieved 2015-12-03.
  11. 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]).
  12. Draelos ZD, Rizer RL, Trookman NS (March 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.
  13. "Neosporin Would Care FAQs". Neosporin. Retrieved 8 May 2015.
  14. Sheth VM, Weitzul S (2008). "Postoperative topical antimicrobial use". Dermatitis. 19 (4): 181–9. doi:10.2310/6620.2008.07094. PMID 18674453.
  15. Martin D (14 September 2011). "MRSA in U.S. becoming resistant to over the counter ointment". CNN. Retrieved 2 June 2012.
  16. Suzuki M, Yamada K, Nagao M, Aoki E, Matsumoto M, Hirayama T, et al. (October 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.
  17. Spann CT, Taylor SC, Weinberg JM (July 2004). "Topical antimicrobial agents in dermatology". Disease-a-Month. 50 (7): 407–21. doi:10.1016/j.disamonth.2004.05.011. PMID 15280871.
  18. Trookman NS, Rizer RL, Weber T (March 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.
  19. "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.
  20. "Neomycin Details". MedsChat.com. Retrieved 8 May 2015.
  21. "Neomycin Sulfate". RxList. Retrieved 8 May 2015.
  22. "Neomycin". Health24. Archived from the original on 26 June 2015. Retrieved 8 May 2015.
  23. "Pramoxine". Medicine Plus. Retrieved 8 May 2015.
  24. "neomycin and polymyxin b sulfates and gramicidin- neomycin sulfate, polymyxin b sulfate and gramicidin solution/ drops". DailyMed. 2 June 2016. Retrieved 13 April 2020.
  25. US 2804421, "Tetracycline type antibiotic ointment"
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