Aminoglycoside antibiotic (topical/oral)
Neomycin sulfate
Adult dose
Dose: Hepatic encephalopathy (alternative to lactulose/rifaximin): 4–12g/day in divided doses. Topical/otic per formulation
Route: PO/Topical
Frequency: divided
Clinical pearls
- Largely superseded by rifaximin for hepatic encephalopathy
- Topical use limited by sensitisation and ototoxicity through perforations
Contraindications
- Intestinal obstruction
- Hypersensitivity
- Perforated tympanic membrane (ototoxicity)
Side effects
- Ototoxicity
- Nephrotoxicity (oral absorption raised in renal/hepatic impairment)
- Malabsorption
- Hypersensitivity
Interactions
- Loop diuretics (ototoxicity)
- Other nephrotoxics
- Methotrexate
- Vitamin K (reduced absorption)
Monitoring
- Renal function
- Audiometry if prolonged
Reference: BNF; NICE; https://bnf.nice.org.uk/drugs/neomycin-sulfate/. Verify against your local formulary and the latest BNF before prescribing.
Related
Curated clinical cross-links plus same-class fallbacks.
Calculators
- DOAC Score for Selecting Direct Oral Anticoagulant in Non-Valvular AF · Anticoagulation
- Centor / McIsaac Score for Strep Pharyngitis · Throat
- Ideal Body Weight (Devine) · Anthropometry
- FeverPAIN Score for Strep Throat · Throat
- Jarisch-Herxheimer Reaction Severity Assessment · Treatment Reactions
- PID Severity (CDC Diagnostic Criteria) · Gynaecological Infections
Pathways
- Infective Endocarditis · ESC 2023 Infective Endocarditis Guidelines; NICE NG41
- Eczema Herpeticum · BAD; NICE CKS
- Suspected Bacterial Meningitis (Adult) · NICE NG240 (2024); NICE NG143 (paeds)
- Clostridioides difficile Colitis · NICE NG199 (2021); IDSA/SHEA 2021
- Returning Traveller — Fever · NaTHNaC; PHE; ESCMID 2018
- Malaria — Diagnosis & Management · PHE 2016; WHO 2023