Neomycin/polymyxin B/bacitracin explained

Neomycin/polymyxin B/bacitracin, also known as triple antibiotic ointment, is an antibiotic medication used to reduce the risk of infections following minor skin injuries.[1] [2] It contains the three antibiotics neomycin, polymyxin B, and bacitracin.[1] It is for topical use.[3]

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

The combination is available over the counter in the US.[4] In 2021, it was the 376th most commonly prescribed medication in the United States, with more than 25,000 prescriptions.[5]

Medical uses

Neomycin/polymyxin B/bacitracin ointment is reported to be a safe and effective topical agent for preventing infections in minor skin trauma.[6]

It is used for burns, scratches, cuts, and minor skin infections.[7]

The use of neomycin/polymyxin B/bacitracin, decreases infection rates in minor-contaminated wounds.[8]

It is for external use only.

Side effects

It has been shown to cause contact dermatitis in some cases.[9]

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,[10] specifically the highly lethal strain.[11] [12] [13]

Components

The 2023 updated Johnson & Johnson Consumer Inc. label for their product discloses three different antibiotics: bacitracin zinc 400 units; neomycin sulfate 3.5 mg; and polymyxin B sulfate 5,000 units; in a relatively low-molecular-weight base of petroleum jelly, cottonseed oil, olive oil, cocoa butter; with sodium pyruvate, and tocopheryl acetate.[14]

The generic name for these products, regardless of the base, is "triple antibiotic ointment".In China, the product (with lidocaine) 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.[15]

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

A variant of Polysporin, called Polysporin Triple Ointment, replaces neomycin with gramicidin, providing an alternative for those allergic to neomycin while still offering broad-spectrum coverage against both Gram-negative and Gram-positive bacteria.[16]

Active ingredients

The three main active ingredients in Neosporin are neomycin sulfate, polymyxin B sulfate, and bacitracin zinc.[17]

One of the main components is neomycin sulfate, which is a type of antibiotic discovered in 1949 by microbiologist Selman Waksman at Rutgers University.[18] 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.[19] 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.[20] As a result of damaged membrane, the affected bacterial cells die, and the infection is prevented or limited.

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.[21]

In some countries bacitracin is replaced with gramicidin.[22] The original Neosporin was using this combination.[23]

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 in August 1951.[24]

The brand Neosporin was first used in commerce in August 1952, and trademarked in October 1952.[25]

External links

Notes and References

  1. Web site: neomycin, bacitracin, polymyxin B ointment . dailymed.nlm.nih.gov. National Institutes of Health. US . 19 April 2019.
  2. Web site: Neomycin and polymyxin B sulfates and bacitracin zinc ophthalmic ointment. 19 April 2019. . FDA.gov.
  3. Zintel HA, Ma RA . The absorption, distribution, excretion and toxicity of bacitracin in man . The American Journal of the Medical Sciences . 218 . 4 . 439–445 . October 1949 . 18140540 . 10.1097/00000441-194910000-00012 . 2371497 .
  4. Web site: Neomycin, polymyxin b, and bacitracin Topical Advanced Patient Information . Drugs.com . 19 April 2019 .
  5. Web site: Bacitracin; Neomycin; Polymyxin B - Drug Usage Statistics . ClinCalc . 14 January 2024.
  6. Bonomo RA, Van Zile PS, Li Q, Shermock KM, McCormick WG, Kohut B . 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 . October 2007 . 17914912 . 10.1586/14787210.5.5.773 . 31594289 .
  7. Web site: Neosporin (neo-bac-polym) topical : Uses, Side Effects, Interactions, Pictures, Warnings & Dosing - WebMD. WebMD. 3 December 2015 .
  8. Diehr S, Hamp A, Jamieson B, Mendoza M . Clinical inquiries. Do topical antibiotics improve wound healing? . The Journal of Family Practice . 56 . 2 . 140–144 . February 2007 . 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]). .
  9. Sheth VM, Weitzul S . Postoperative topical antimicrobial use . Dermatitis . 19 . 4 . 181–189 . 2008 . 18674453 . 10.2310/6620.2008.07094 .
  10. Web site: MRSA in U.S. becoming resistant to over the counter ointment. Martin D. 14 September 2011. CNN. 2 June 2012. 4 January 2012. https://web.archive.org/web/20120104104223/http://thechart.blogs.cnn.com/2011/09/14/mrsa-in-u-s-becoming-resistant-to-over-the-counter-ointment/. dead.
  11. Suzuki M, Yamada K, Nagao M, Aoki E, Matsumoto M, Hirayama T, Yamamoto H, Hiramatsu R, Ichiyama S, Iinuma Y . Antimicrobial ointments and methicillin-resistant Staphylococcus aureus USA300 . Emerging Infectious Diseases . 17 . 10 . 1917–1920 . October 2011 . 22000371 . 3310646 . 10.3201/eid1710.101365 .
  12. Spann CT, Taylor SC, Weinberg JM . Topical antimicrobial agents in dermatology . Disease-a-Month . 50 . 7 . 407–421 . July 2004 . 15280871 . 10.1016/j.disamonth.2004.05.011 .
  13. Trookman NS, Rizer RL, Weber T . 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 . March 2011 . 21247665 . 10.1016/j.jaad.2010.11.011 . free .
  14. Web site: Drug Label Information Updated January 9, 2023 . DailyMed, National Library of Medicine.
  15. 5 June 1997 . McNeil Consumer Products Co. strengthens worldwide lead in OTC pain reliever market. Business Wire . Fort Washington, Pennsylvania . 28 June 2011 . 5 March 2016 . https://web.archive.org/web/20160305051620/http://www.thefreelibrary.com/-a019478196. dead.
  16. Web site: CTC Health. (n.d.). Polysporin Triple Ointment . 2 April 2023 . ctchealth.ca.
  17. Web site: Neosporin (topical) Uses, Side Effects & Warnings . Drugs.com . 19 April 2019 .
  18. Web site: Neomycin Details. MedsChat.com. 8 May 2015.
  19. Web site: Neomycin Sulfate. RxList. 8 May 2015.
  20. Web site: Neomycin. Health24. 8 May 2015. 26 June 2015. https://web.archive.org/web/20150626114322/http://www.health24.com/Medical/Meds-and-you/Medication/Neomycin-Client-20120721. dead.
  21. Web site: Pramoxine. Medicine Plus. 8 May 2015.
  22. Web site: neomycin and polymyxin b sulfates and gramicidin- neomycin sulfate, polymyxin b sulfate and gramicidin solution/ drops . DailyMed . 2 June 2016 . 13 April 2020.
  23. Web site: Drug 060582 original approval package . FDA.gov.
  24. Tetracycline type antibiotic ointment. US . 2804421.
  25. Web site: Trademark Status & Document Retrieval . 12 February 2024 . tsdr.uspto.gov.

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