Usage
This combination medication is prescribed for the treatment of superficial bacterial infections of the skin and the reduction of associated inflammation (swelling, redness, itching). It is effective against a range of gram-positive and gram-negative bacteria.
Pharmacological Classification:
- Bacitracin and Polymyxin B: Polypeptide antibiotics
- Neomycin: Aminoglycoside antibiotic
- Hydrocortisone: Corticosteroid
Mechanism of Action:
- Bacitracin inhibits bacterial cell wall synthesis.
- Polymyxin B disrupts the bacterial cell membrane.
- Neomycin inhibits bacterial protein synthesis.
- Hydrocortisone provides anti-inflammatory and antipruritic effects.
Alternate Names
This combination drug is often referred to by its components. Brand names include Cortisporin, Neo-Polycin HC, Neotricin HC, Ocu-Cort and AK-Spore HC.
How It Works
Pharmacodynamics:
- The antibiotics act synergistically to kill bacteria by targeting different aspects of bacterial structure and function.
- Hydrocortisone, through binding to glucocorticoid receptors, reduces inflammation by suppressing the immune response, decreasing vasodilation and capillary permeability, and inhibiting the production of inflammatory mediators.
Pharmacokinetics:
- Topical application results in minimal systemic absorption.
- When absorbed systematically, components are metabolized primarily by the liver (hydrocortisone) and excreted by the kidneys (neomycin and hydrocortisone). Bacitracin is eliminated by a combination of renal and non-renal mechanisms. Polymyxin B is eliminated by renal mechanisms.
Mode of Action:
- Bacitracin blocks dephosphorylation of the lipid carrier molecule responsible for transporting peptidoglycans for cell wall synthesis.
- Polymyxin B binds to phospholipids in the bacterial cell membrane, increasing its permeability.
- Neomycin binds to the 30S ribosomal subunit, disrupting protein synthesis.
- Hydrocortisone binds to glucocorticoid receptors in the cytoplasm, translocates to the nucleus, and modulates gene expression related to inflammation.
Elimination Pathways:
- Renal excretion (neomycin, hydrocortisone, polymyxin B).
- Hepatic metabolism (hydrocortisone).
- Other non-renal mechanisms (bacitracin).
Dosage
Standard Dosage
Adults:
A thin layer of ointment or cream should be applied to the affected area 2-4 times daily.
Children:
Similar dosing as adults, but use should be limited to smaller surface areas. Pediatric safety considerations include increased risk of systemic absorption and adrenal suppression with prolonged use.
Special Cases:
- Elderly Patients: No specific dose adjustment is typically required, but monitor for systemic side effects.
- Patients with Renal Impairment: Use with caution due to potential neomycin and polymyxin B toxicity.
- Patients with Hepatic Dysfunction: Monitor patients for increased systemic effects of hydrocortisone.
- Patients with Comorbid Conditions: Use with caution in patients with diabetes, as hydrocortisone can affect blood glucose levels.
Clinical Use Cases
This combination drug is typically not used in these clinical settings. It is primarily indicated for topical treatment of superficial skin infections.
Dosage Adjustments
No standard dosage adjustments are provided in manufacturer labeling.
Side Effects
Common Side Effects
- Local irritation (burning, itching, stinging).
- Dryness.
- Redness.
Rare but Serious Side Effects
- Allergic contact dermatitis.
- Skin atrophy.
- Secondary infection.
- Ototoxicity (if used in or near the ear).
- Nephrotoxicity (with systemic absorption).
Long-Term Effects
- Skin thinning.
- Telangiectasia.
- Hypopigmentation.
Adverse Drug Reactions (ADR)
- Severe allergic reactions (anaphylaxis).
- Stevens-Johnson syndrome.
Contraindications
- Hypersensitivity to any of the components.
- Viral skin infections (herpes simplex, varicella zoster).
- Fungal skin infections.
- Extensive burns or damaged skin.
Drug Interactions
- Other topical medications applied to the same area.
- Systemic aminoglycosides (increased risk of nephrotoxicity and ototoxicity).
- Neuromuscular blocking agents (potentiated effects).
Pregnancy and Breastfeeding
- Pregnancy Safety Category: C (topical); Not formally assigned to a category.
- Fetal risks include potential teratogenicity from hydrocortisone, particularly with high concentrations or prolonged exposure.
- Limited information on drug excretion in breast milk. Exercise caution and wipe off any medication prior to breastfeeding if applied to the breast area.
Drug Profile Summary
- Mechanism of Action: Combined antibiotic and anti-inflammatory action.
- Side Effects: Local irritation, allergic reactions, skin atrophy (long-term use).
- Contraindications: Hypersensitivity, viral/fungal infections, extensive burns.
- Drug Interactions: Other topical agents, systemic aminoglycosides, neuromuscular blocking agents.
- Pregnancy & Breastfeeding: Use with caution if benefits outweigh risks.
- Dosage: Apply thin layer to affected area 2-4 times daily.
- Monitoring Parameters: Observe the affected area for signs of healing or adverse reactions.
Popular Combinations
This medication is typically used as a stand-alone topical treatment.
Precautions
- General Precautions: Avoid contact with eyes, mucous membranes, and open wounds.
- Specific Populations: Use with caution in pregnant/breastfeeding women and children.
- Lifestyle Considerations: No specific lifestyle considerations apply to this medication.
FAQs (Frequently Asked Questions)
Q1: What is the recommended dosage for Bacitracin + Hydrocortisone + Neomycin + Polymyxin B?
A: Apply a thin layer to the affected area 2-4 times daily.
Q2: What infections does this medication treat?
A: It treats superficial bacterial skin infections.
Q3: Can this medication be used during pregnancy?
A: Use with caution if benefits outweigh risks. Consult with a healthcare provider.
Q4: What are the common side effects?
A: Common side effects include local irritation, such as burning, itching, and redness.
Q5: Can this ointment be used near the eyes?
A: There are specific ophthalmic formulations for use near the eyes. Do not use the skin ointment in or near the eye.
Q6: How long should this medication be used?
A: Use as directed by a healthcare professional, typically for no more than 7 days.
Q7: What should I do if my symptoms don’t improve?
A: Consult with a healthcare professional if symptoms do not improve after a few days.
Q8: Is it safe to use this medication on broken skin?
A: Yes, it can be used on minor cuts, scrapes, and burns to prevent infection.
Q9: What are the signs of an allergic reaction to this medication?
A: Allergic reactions can include rash, hives, itching, swelling, and difficulty breathing. Seek immediate medical attention if you experience any of these symptoms.
