Precautions and warnings

Only after a physician has examined the patient with magnification, such as slit-lamp biomicroscopy and, where needed, fluorescein staining, should the original prescription and renewal of the drug order beyond 8 grams be written. The patient should be re-evaluated if the signs and symptoms do not improve after two days.

Because fungal infections of the cornea are more likely to develop in conjunction with long-term corticosteroid usage, fungal invasion should be suspected in any persistent corneal ulceration where a corticosteroid has been taken or is currently being used. When necessary, fungal cultures should be obtained. Intraocular pressure should be monitored if this product is used for more than 10 days.

There have been instances of bacterial keratitis caused by the unintended contamination of topical ophthalmic medications in multiple-dose containers by patients, the majority of whom had a concomitant corneal disease or a disruption of the ocular epithelial surface.

Allergic cross-reactions may occur, preventing the use of any or all of the antibiotics kanamycin, paromomycin, streptomycin, and probable gentamicin for the treatment of subsequent infections.

Drug Interactions

When used with other nephrotoxic medicines, bacitracin zinc increases the risk of nephrotoxicity. It's possible that it boosts the effects of neuromuscular blockers.

Other aminoglycosides (for example, paromomycin), bacitracin, cisplatin, vancomycin, amphotericin B, polymyxin B, colistin, and viomycin have additive nephrotoxic and neurotoxic effects. Increased toxicity in combination with diuretics (for example, ethacrynic acid, furosemide). Other medications' absorption may be hampered (for example, phenoxymethylpenicillin, digoxin, methotrexate and some vit). It's possible that OCs' efficacy will be reduced. Acarbose's impact may be enhanced. Non-depolarizing muscle relaxants may be enhanced by this compound. It's possible that it'll counteract the parasympathomimetic effects of neostigmine and pyridostigmine. In patients using bisphosphonates, it may raise the risk of hypocalcemia. When taken with anticoagulants, it may cause an increase in INR. Oral typhoid vaccination may be rendered ineffective.

Polymixin B is a protein that has the potential to be fatal. With bacitracin, streptomycin, neomycin, kanamycin, gentamicin, tobramycin, amikacin, cephaloridine, paromomycin, viomycin, and colistin, it has an additive neurotoxic or nephrotoxic impact. Neuromuscular blockers increase the chance of resp plegia (for example, anesthetics, muscle relaxants).

Contraindications

Most viral diseases of the cornea and conjunctiva, such as epithelial herpes simplex keratitis (dendritic keratitis), vaccinia, and varicella, as well as mycobacterial infection of the eye and fungal diseases of ocular structures, are contraindicated with neomycin and polymyxin B sulfates and bacitracin zinc with hydrocortisone acetate ophthalmic Individuals who have proven hypersensitivity to any of the components of neomycin, polymyxin B sulfates, and bacitracin zinc with hydrocortisone acetate eye ointment should not use it. Antibiotic hypersensitivity is more common than hypersensitivity to other components.

Mode of actions

Neomycin binds to the 30S subunits of the bacterial ribosome, limiting protein synthesis and hence affecting DNA synthesis. It has an antibacterial spectrum similar to gentamicin. It's effective against a wide range of gram-negative bacteria, as well as some staphylococci strains.

Bacitracin, on the other hand, inhibits bacterial cell wall formation and is effective against a wide range of gram-positive and gram-negative bacteria (including staphylococci, streptococci, corynebacteria, and clostridia) (for example, Neisseria and Haemophilus influenzae). As broad-spectrum antibacterial agents, they are frequently used in combination in topical treatments.

Polymyxin B binds to membrane phospholipids and breaks the cytoplasmic membrane of primarily gm-ve bacteria, allowing intracellular components to flow out.

Dosage & Administration

Apply the ointment in the affected eye every 3 or 4 hours, depending on the severity of the condition. Not more than 8 grams should be prescribed initially and the prescription should not be refilled without further evaluation as outlined in precaution above.

Pregnancy & Lactation

Although animal reproduction studies have shown an adverse effect on the fetus and there are no adequate and well-controlled studies in pregnant women, but during pregnancy, this medicine can be used just when definitely required despite potential risks.

Mothers with a newborn baby who have used this drug during the last 3 months of pregnancy may seldom create symptoms including drowsiness, muscle stiffness or shakiness, feeding or breathing troubles, constant crying. If you notice any of these symptoms of your baby's particularly during their first month, tell the doctor immediately.

This medicine passes into breast milk. Talk to your doctor before breastfeeding.

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