Hydrocortisone with neomycin and polymyxin B

How it works

Neomycin (an aminoglycoside) and polymyxin B provide complementary antibacterial cover against Gram-positive and Gram-negative organisms, while hydrocortisone reduces local inflammation.

Prescribing in practice

• Avoid use in the ear when the tympanic membrane is perforated, as topical neomycin (an aminoglycoside) carries a risk of ototoxicity in the middle ear.
• Neomycin is a common contact sensitiser, so discontinue if local hypersensitivity develops.
• Reserve for short courses and reassess if there is no improvement to limit sensitisation and superinfection.

Monitoring

Monitor for clinical improvement and for any local hypersensitivity or, with ear use, hearing disturbance during treatment.

Counselling the patient

• Use only at the affected site and complete the short course as directed.
• Stop and seek advice if you develop a rash, itching or, with ear use, hearing changes or dizziness.
• Tell the clinician if your eardrum may be perforated before using drops in the ear.

Evidence & guidelines

Combined antibiotic-corticosteroid topical preparations are established for infected otitis externa and external eye infection, used cautiously per UK guidance.