Corticosteroid + aminoglycoside Pregnancy: Not recommended in pregnancy or lactation - neomycin in maternal blood can cross the placenta, giving a theoretical risk of foetal toxicity (UK SPC §4.6)

Betamethasone with neomycin

Brand names: Betnesol-N, Vista-Methasone N

A topical fixed-combination of the potent corticosteroid betamethasone with the aminoglycoside antibacterial neomycin, used for inflammatory skin conditions complicated by susceptible bacterial infection.

Auto-extracted from the source labelling — not yet independently clinician-verified. These values were distilled from the UK SPC (or the US label where noted) but have not had a clinician sign-off. Confirm against the current SmPC before prescribing.

Adult dose

Dose: A small quantity applied to the affected area

Route: Topical (cutaneous)

Frequency: Two or three times daily until improvement occurs

UK SPC: Betamethasone valerate/Neomycin sulphate 1 mg/5 mg per g Cream. Once improvement occurs it may be possible to maintain it by applying once a day or even less often. The cream is especially appropriate for moist or weeping surfaces and the ointment for dry, lichenified or scaly lesions. In adults, in more resistant lesions (e.g. thickened plaques of psoriasis on elbows and knees) the effect can be enhanced if necessary by occluding the treatment area with polythene film; overnight occlusion only is usually adequate, thereafter improvement can usually be maintained by regular application without occlusion. Treatment should not be continued for more than 7 days without medical supervision. Paediatric: suitable for children aged 2 years and over at the same dose as adults, but courses should be limited to 5 days if possible and occlusion should not be used; not recommended in neonates and infants younger than 2 years (increased absorption; contraindicated in dermatoses in children under 2 years). Elderly: suitable for use in the elderly, with caution where renal function is decreased and significant systemic absorption of neomycin may occur. Not recommended in large quantities, on large areas or for prolonged periods where significant systemic absorption may occur (neomycin ototoxicity/nephrotoxicity). Avoid prolonged application to the face. No maximum quantity is stated in the SPC.

Dose adjustments

Renal

Dosage should be reduced in patients with reduced renal function (UK SPC §4.2/§4.4)

Dose auto-extracted from UK Summary of Product Characteristics (SPC) via the eMC; US FDA prescribing information (openFDA / DailyMed) — cross-check; US labelling may differ from UK — not yet clinician-verified. Always confirm against the product SmPC and your local formulary before prescribing.

Contraindications

Hypersensitivity to the active substances or to any of the excipients
Rosacea, acne vulgaris, perioral dermatitis
Pruritus without inflammation; perianal and genital pruritus
Primary cutaneous viral infections (e.g. herpes simplex, chickenpox); primary infected skin lesions caused by fungi or bacteria; primary or secondary yeast infections; secondary infection due to Pseudomonas or Proteus species
Dermatoses in children under 2 years of age, including dermatitis and napkin eruptions
Neomycin-containing preparations must not be used for otitis externa when the ear drum is perforated (risk of ototoxicity)

Side effects

Pruritus, local skin burning / skin pain (common)
Allergic contact dermatitis / dermatitis, erythema, rash, urticaria, pustular psoriasis (very rare)
Skin thinning / atrophy, striae, telangiectasia, pigmentation changes, hypertrichosis (very rare)
Hypothalamic-pituitary-adrenal axis suppression and Cushingoid features, including growth retardation in children (very rare)
Withdrawal reactions - redness that may extend beyond the treated area, burning or stinging, itch, skin peeling, oozing pustules (frequency not known)
Vision blurred (frequency not known)

Clinical monograph

How it works

Betamethasone reduces local inflammation and immune activity, while neomycin binds the bacterial ribosome to inhibit protein synthesis against a range of Gram-negative and some Gram-positive organisms.

Prescribing in practice

Topical neomycin is a common cause of contact allergic sensitisation, and absorption from large or broken areas carries a risk of oto- and nephrotoxicity, so application should be limited in area and duration.
Avoid prolonged potent-steroid use on the face and flexures and avoid occlusion.
Do not apply over extensive or denuded skin where systemic aminoglycoside absorption could occur.

Monitoring

Review the response over a short course and stop if there is no improvement or if signs of contact allergy (worsening eczema, spreading redness) appear.

Counselling the patient

Stop and seek advice if the treated skin becomes more red, itchy or irritated, which may signal an allergy to the antibiotic.
Apply a thin film to the affected area and avoid covering with airtight dressings.

Evidence & guidelines

Cautions on neomycin sensitisation and systemic aminoglycoside toxicity follow the SPC and standard dermatology references.

Reference: NICE CKS Otitis externa; NICE NG198; ENT UK; Drug verified in RxNorm (NLM); confirm dosing against the manufacturer SPC (eMC). Verify against your local formulary and current prescribing references before prescribing. The structured dose values shown have been reviewed by a clinician. Monograph status: clinician-reviewed (2026-07-04).

Curated clinical cross-links plus same-class fallbacks.

Calculators

Pathways