Version May 2024
Urinary bladder irrigant: Intravesical: Add 1 mL irrigant to 1,000 mL isotonic saline solution per day as a continuous irrigation for up to 10 days.
Dosage adjustment for concomitant therapy: Significant drug interactions exist, requiring dose/frequency adjustment or avoidance. Consult drug interactions database for more information.
There are no dosage adjustments provided in the manufacturer’s labeling. Use with caution; systemic absorption is low, however, absorption from the denuded bladder surface has been reported and risk for toxicity is increased in patients with renal impairment.
There are no dosage adjustments provided in the manufacturer’s labeling.
Refer to adult dosing.
(For additional information see "Neomycin and polymyxin B: Pediatric drug information")
Urinary bladder irrigant: Limited data available (Elliott 2005); efficacy results variable (Warren 1978); most experience in patients with neurogenic bladder or spinal cord injury: Children and Adolescents: Irrigant solution (neomycin 40 mg/polymyxin B 200,000 units/L): Intravesical: 10 mL instilled at the end of each catheterization and retained until next catheterization (Mulcahy 1979); in older adolescents, 30 mL 2 to 3 times daily has been used for asymptomatic bacteriuria (Linsenmeyer 1999; Waites 2006). Note: Use has generally been replaced with other agents (eg, saline, gentamicin) (Defoor 2006; Dray 2017; van den Heijkant 2011; van Nieuwkoop 2010).
Dosage adjustment for concomitant therapy: Significant drug interactions exist, requiring dose/frequency adjustment or avoidance. Consult drug interactions database for more information.
Children and Adolescents: In pediatric patients with ESRD, systemic absorption from the bladder may occur; use with caution and monitor serum levels (deJong 1993).
There are no dosage adjustments provided in the manufacturer’s labeling.
The following adverse drug reactions are derived from product labeling unless otherwise specified.
Postmarketing: Genitourinary: Bladder mucosa irritation
Hypersensitivity to neomycin, polymyxin B, or any component of the formulation; history of a serious toxic reaction to an aminoglycoside
Concerns related to adverse effects:
• Superinfection: Prolonged use may result in fungal or bacterial superinfection, including C. difficile-associated diarrhea (CDAD) and pseudomembranous colitis; CDAD has been observed >2 months postantibiotic treatment.
• Systemic toxicity: Ototoxicity, nephrotoxicity, and neuromuscular blockade may occur if systemically absorbed. Avoid use in patients with defects in the bladder mucosa or bladder wall (eg, vesical rupture) or in association with operative procedure on the bladder wall due to the risk of systemic toxicity; absorption of neomycin from the denuded bladder surface has been reported.
Disease-related concerns:
• Renal impairment: Use with caution in patients with renal impairment; risk for toxicity is increased.
Special populations:
• Dehydrated patients: Use with caution; risk for toxicity is increased.
• Older adult: Use with caution; risk for toxicity is increased.
• Pediatric: Use with caution in infants; risk for toxicity is increased.
Other warnings/precautions:
• Appropriate use: Irrigant is for urinary bladder irrigation only. Risk of systemic toxicity is low if irrigation of intact urinary bladder does not exceed 10 days.
• Prolonged treatment: Patients receiving high doses of prolonged treatment are at increased risk for toxicity.
In general, systemic absorption from the bladder not usually observed (Chamberlain 1976). Ototoxicity has been reported in a 5 year old child with end-stage renal disease (ESRD) receiving neomycin 3 times weekly bladder irrigation for 6 weeks; at time ototoxicity reported, the serum neomycin concentration was 16 mg/L and persisted for 1 week (de Jong 1993).
Excipient information presented when available (limited, particularly for generics); consult specific product labeling. [DSC] = Discontinued product
Solution, irrigation:
Generic: Neomycin 40 mg and polymyxin B sulfate 200,000 units per 1 mL (1 mL, 20 mL)
Yes
Solution (Neosporin GU Irrigant Irrigation)
40-200000 (20 mL): $415.55
Disclaimer: The pricing data provide a representative AWP and/or AAWP price from a single manufacturer of the brand and/or generic product, respectively. The pricing data should be used for benchmarking purposes only, and as such should not be used to set or adjudicate any prices for reimbursement or purchasing functions. Pricing data is updated monthly.
For bladder irrigation only; not for injection. Connect irrigation container to the inflow lumen of a 3-way catheter to permit continuous irrigation of the urinary bladder. Rinsing of the bladder should be continuous; the inflow or rinse solution should not be interrupted for more than a few minutes. Adjust flow rate to 1,000 mL/24 hours; if patient’s urine output exceeds 2,000 mL/day, increase flow rate to 2,000 mL/24 hours.
Bladder irrigant: Do not inject irrigant solution; concentrated irrigant solution must be diluted prior to administration.
Intermittent irrigation: Children and Adolescents: Attach to urinary catheter and instill dose volume at the end of catheterization (Huynh 2011; Linsenmeyer 1999; Mulcahy 1979; Waites 2006).
Urinary bladder irrigant: Continuous irrigant or rinse for short-term use (up to 10 days) in the urinary bladder of abacteriuric patients to help prevent bacteriuria and gram-negative rod septicemia associated with the use of indwelling catheters.
None known.
There are no known significant interactions.
Animal reproduction studies have not been conducted with this combination; however, there are reports of total irreversible bilateral congenital deafness in children whose mothers received streptomycin during pregnancy. See individual monographs for additional information.
It is not known if neomycin or polymyxin B are excreted into breast milk. See individual agents.
Urinalysis, renal function.
Neomycin: Interferes with bacterial protein synthesis by binding to 30S ribosomal subunits.
Polymyxin B: Binds to phospholipids, alters permeability, and damages the bacterial cytoplasmic membrane permitting leakage of intracellular constituents.
See individual agents.
Absorption: Topical: Clinically insignificant amounts of neomycin and polymyxin B are absorbed following irrigation of an intact urinary bladder. Systemic absorption may occur from a denuded bladder.
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