Dosage Forms
Excipient information presented when available (limited, particularly for generics); consult specific product labeling.
Ointment, Ophthalmic:
Neo-Polycin HC: Bacitracin 400 units, neomycin 3.5 mg, polymyxin B 10,000 units, and hydrocortisone 10 mg per g (3.5 g)
Generic: Bacitracin 400 units, neomycin 3.5 mg, polymyxin B 10,000 units, and hydrocortisone 10 mg per g (3.5 g)
Pharmacology
Mechanism of Action
See individual agents.
Use: Labeled Indications
Inflammatory ocular conditions: Corticosteroid-responsive inflammatory ocular conditions where bacterial infection or risk of bacterial infection exists
Contraindications
Hypersensitivity to bacitracin, neomycin, polymyxin B, hydrocortisone, or any component of the formulation; most viral diseases of the cornea and conjunctiva, including epithelial herpes simplex keratitis (dendritic keratitis), vaccinia and varicella; mycobacterial ophthalmic infection; fungal diseases of ocular structures.
Dosage and Administration
Dosing: Adult
Inflammatory ocular conditions: Ophthalmic: Apply to inside of lower lid of affected eye(s) every 3 or 4 hours (depending on severity of condition)
Dosing: Geriatric
Refer to adult dosing.
Dosing: Pediatric
Inflammatory ocular conditions: Limited data available: Children and Adolescents: Ophthalmic: Apply sparingly to inside of lower lid of affected eye(s) every 3 to 4 hours has been used by some centers; dosing based on experience with other combination ophthalmic products with similar ingredients
Administration
Ophthalmic: For topical ophthalmic use only; apply directly into conjunctival sac. To avoid contamination, do not touch tube tip to eyelids or other surfaces when placing ointment in eye(s).
Storage
Store at 15°C to 30°C (59°F to 86°F).
Drug Interactions
Nonsteroidal Anti-Inflammatory Agents (Ophthalmic): May enhance the adverse/toxic effect of Corticosteroids (Ophthalmic). Healing of ophthalmic tissue during concomitant administration of ophthalmic products may be delayed. Monitor therapy
Ritodrine: Corticosteroids may enhance the adverse/toxic effect of Ritodrine. Monitor therapy
Adverse Reactions
See individual agents.
Warnings/Precautions
Concerns related to adverse effects:
- Infection: Steroids may mask infection, enhance existing ocular infection, or reactivate latent disease (eg, herpes infection of cornea); prolonged use may result in secondary bacterial or fungal superinfection due to immunosuppression. Lack of prompt clinical response may indicate resistance to therapy and warrant discontinuation of therapy and further evaluation.
- Neomycin sensitization: Neomycin may cause cutaneous sensitization. Symptoms of neomycin sensitization include itching, reddening, edema, and failure to heal. Discontinuation of product and avoidance of similar products should be considered.
- Ocular effects: Avoid prolonged use of corticosteroids, which may result in ocular hypertension and/or glaucoma, with damage to the optic nerve, defects in visual acuity and fields of vision, and posterior subcapsular cataract formation. Use with caution in glaucoma. Monitor intraocular pressure (routinely if duration of therapy is >10 days). Long-term use may cause corneal and scleral thinning; potentially resulting in perforation. Ophthalmic ointments may retard corneal wound healing.
Other warnings/precautions:
- Appropriate use: For topical use only. Do not inject subconjunctivally or introduce directly into anterior chamber of the eye. Use following ocular cataract surgery may delay healing and increase the incidence of filtering blebs. Inadvertent contamination of multiple-dose ophthalmic tube tip has caused bacterial keratitis. Use of topical corticosteroids to prevent scarring in the healing stages of herpes simplex infection should be done with extreme caution and close observation; may reactivate disease. A maximum of 8 g should be prescribed initially; reevaluate patients (eg, intraocular pressure and exams using magnification and fluorescein staining, where appropriate) prior to additional refills. Use >10 days should include routine monitoring of intraocular pressure.
Monitoring Parameters
If ophthalmic ointment is used >10 days or in patients with glaucoma, monitor intraocular pressure (IOP).
Pregnancy
Pregnancy Risk Factor
C
Pregnancy Considerations
Adverse events have been observed with topical corticosteroids in animal reproduction studies. If ophthalmic agents are needed during pregnancy, the minimum effective dose should be used in combination with punctal occlusion to decrease potential exposure to the fetus (Samples, 1988). Refer to individual agents.
Patient Education
- Discuss specific use of drug and side effects with patient as it relates to treatment. (HCAHPS: During this hospital stay, were you given any medicine that you had not taken before? Before giving you any new medicine, how often did hospital staff tell you what the medicine was for? How often did hospital staff describe possible side effects in a way you could understand?)
- Have patient report immediately to prescriber vision changes, eye pain, or severe eye irritation (HCAHPS).
- Educate patient about signs of a significant reaction (eg, wheezing; chest tightness; fever; itching; bad cough; blue skin color; seizures; or swelling of face, lips, tongue, or throat). Note: This is not a comprehensive list of all side effects. Patient should consult prescriber for additional questions.
Intended Use and Disclaimer: Should not be printed and given to patients. This information is intended to serve as a concise initial reference for health care professionals to use when discussing medications with a patient. You must ultimately rely on your own discretion, experience, and judgment in diagnosing, treating, and advising patients.
