Neomycin/polymyxin B/bacitracin

Neomycin/polymyxin B/bacitracin
Combination of
Polymyxin B sulfate	Antibiotic
Neomycin sulfate	Antibiotic
Bacitracin zinc	Antibiotic
Clinical data
Trade names	Neosporin, others
AHFS/Drugs.com	Professional Drug Facts
MedlinePlus	a601098
License data	US DailyMed: Neomycin and polymyxin b and bacitracin;
Routes of; administration	Topical, eye drops
ATC code	A07AA51 (WHO) ;
Legal status
Legal status	US: OTC / Rx-only;
Identifiers
CAS Number	8057-37-2 ;
ChemSpider	10481985 ;
KEGG	D02531;
	(verify)

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]^[4]

Possible side effects include itchiness and skin rash,^[5] and in rare cases hearing loss.^[5] 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.^[5] In 2021, it was the 376th most commonly prescribed medication in the United States, with more than 25,000 prescriptions.^[6]

Medical uses

Neomycin/polymyxin B/bacitracin ointment is reported to be a safe and effective topical agent for preventing infections in minor skin trauma.^[3]

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.^[4]

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 ST8:USA300 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 only bacitracin and polymyxin B: one such example is Polysporin branded product.^{[medical citation needed]}

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]^[7]

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.^{[medical citation needed]}

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]

References

^ ^a ^b "neomycin, bacitracin, polymyxin B ointment". dailymed.nlm.nih.gov. US: National Institutes of Health. Retrieved 19 April 2019.
^ ^a ^b "Neomycin and polymyxin B sulfates and bacitracin zinc ophthalmic ointment" (PDF). FDA.gov. U.S. Food and Drug Administration. Retrieved 19 April 2019.
^ ^a ^b 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): 773–782. doi:10.1586/14787210.5.5.773. PMID 17914912. S2CID 31594289.
^ ^a ^b Zintel HA, Ma RA (October 1949). "The absorption, distribution, excretion and toxicity of bacitracin in man". The American Journal of the Medical Sciences. 218 (4): 439–445. doi:10.1097/00000441-194910000-00012. PMID 18140540. S2CID 2371497.
^ ^a ^b ^c "Neomycin, polymyxin b, and bacitracin Topical Advanced Patient Information". Drugs.com. Retrieved 19 April 2019.
^ "Bacitracin; Neomycin; Polymyxin B - Drug Usage Statistics". ClinCalc. Retrieved 14 January 2024.
^ ^a ^b "Neosporin (neo-bac-polym) topical : Uses, Side Effects, Interactions, Pictures, Warnings & Dosing - WebMD". WebMD. Retrieved 3 December 2015.
^ 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): 140–144. 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]).
^ Sheth VM, Weitzul S (2008). "Postoperative topical antimicrobial use". Dermatitis. 19 (4): 181–189. doi:10.2310/6620.2008.07094. PMID 18674453.
^ Martin D (14 September 2011). "MRSA in U.S. becoming resistant to over the counter ointment". CNN. Archived from the original on 4 January 2012. Retrieved 2 June 2012.
^ 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): 1917–1920. doi:10.3201/eid1710.101365. PMC 3310646. PMID 22000371.
^ Spann CT, Taylor SC, Weinberg JM (July 2004). "Topical antimicrobial agents in dermatology". Disease-a-Month. 50 (7): 407–421. doi:10.1016/j.disamonth.2004.05.011. PMID 15280871.
^ 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.
^ "Drug Label Information Updated January 9, 2023". DailyMed, National Library of Medicine.
^ "McNeil Consumer Products Co. strengthens worldwide lead in OTC pain reliever market". Business Wire (Press release). Fort Washington, Pennsylvania. 5 June 1997. Archived from the original on 5 March 2016. Retrieved 28 June 2011.
^ "CTC Health. (n.d.). Polysporin Triple Ointment". ctchealth.ca. Retrieved 2 April 2023.
^ "Neosporin (topical) Uses, Side Effects & Warnings". Drugs.com. Retrieved 19 April 2019.
^ "Neomycin Details". MedsChat.com. Retrieved 8 May 2015.
^ "Neomycin Sulfate". RxList. Retrieved 8 May 2015.
^ "Neomycin". Health24. Archived from the original on 26 June 2015. Retrieved 8 May 2015.
^ "Pramoxine". Medicine Plus. Retrieved 8 May 2015.
^ "neomycin and polymyxin b sulfates and gramicidin- neomycin sulfate, polymyxin b sulfate and gramicidin solution/ drops". DailyMed. 2 June 2016. Retrieved 13 April 2020.
^ "Drug 060582 original approval package" (PDF). FDA.gov.
^ US 2804421, "Tetracycline type antibiotic ointment"
^ "Trademark Status & Document Retrieval". tsdr.uspto.gov. Retrieved 12 February 2024.