Betamethasone with neomycin

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.