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Neomycyna - Skuteczny Lek na Pryszcze?
Toxicity
Neomycin holds a pivotal role in the treatment of hepatic encephalopathy and perioperative prophylaxis. Due to the drug's potential for various toxicities, having a comprehensive medical history centered on renal, otological, and neurological conditions is imperative before considering a neomycin prescription. Patients should be well-informed about the advantages and potential risks of neomycin therapy. Furthermore, conducting baseline and regular laboratory assessments is essential to monitor for any indications of end-organ damage in patients.
The recommended course of action for patients receiving neomycin is as follows:
Physicians and advanced practice practitioners usually prescribe the medicine.The internist is responsible for determining the appropriate indication for neomycin in hepatic coma.
The surgeon is responsible for identifying the proper indication of neomycin in surgical prophylaxis.
A nephrologist consultation is necessary if the patient develops nephrotoxicity. An otorhinolaryngologist consultation should be initiated if the patient develops ototoxicity.A neurologist consultation is necessary if the patient develops neurotoxicity and neuromuscular blockade.
An intensivist is required for ICU care to determine the need for mechanical ventilation in severe toxicity.
Pharmacists assume responsibility for crucial aspects of patient care, including medication reconciliation, thorough assessment of potential drug interactions, patient counseling, verifying accurate drug dosing, and providing comprehensive responses to clinician inquiries.
Specially trained nursing staff are responsible for administering neomycin at the designated intervals, maintaining detailed records of patients, providing attentive care to hospitalized patients, and counseling patients regarding their medication regimens.
Residents contribute significantly to the continuity of patient care and engage in patient education efforts.
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Mechanism of Action
Neomycin's mechanism of action is very similar to most aminoglycosides, whereby it binds to the 30S ribosomal subunit, impeding bacterial protein synthesis. Although the initial stages required for peptide synthesis proceed without interruption, the subsequent elongation process is hindered due to the disruption of translational accuracy. Consequently, this disturbance in the bacteria's translation process contributes to the medication's bactericidal effects.[1][5]
The pathogenesis of hepatic coma frequently stems from underlying liver disease, resulting in elevated ammonia levels in the bloodstream. Ammonia can traverse the blood-brain barriers at high levels, thereby giving rise to numerous neurological manifestations associated with hepatic coma. Furthermore, ammonia within the brain instigates heightened levels of glutamine and lactate, contributing to neuronal edema.[6] Therefore, therapeutic approaches are focused on reducing ammonia levels through the attenuation of ammonia production or the enhancement of ammonia excretion.
Neomycin's bactericidal effects decrease ammonia-producing bacteria in the GI tract, thereby decreasing the ammonia burden on the patient.[2] Neomycin is often reserved for patients unable to tolerate rifaximin. Neomycin is less commonly utilized due to its more significant adverse effect profile associated with long-term use.[7] In addition, it is essential to recognize that using poorly absorbed antibiotics, such as rifaximin and neomycin, constitutes a second-line approach when compared to synthetic disaccharides, such as lactulose and lactitol. In clinical practice, a standard method involves combining these antibiotics with synthetic disaccharides.
Neomycin's limited absorption from the GI tract renders it a suitable option for perioperative bowel preparation, as it exerts its effects primarily within the intestinal area with minimal systemic circulation. Neomycin is frequently paired with erythromycin in a regimen administered one day before surgery. This combination diminishes the bacterial load within the colon, thereby mitigating the potential for surgical site infections. Metronidazole could be considered an alternative option due to its improved tolerability compared to erythromycin. These antibiotics are integral to a regimen involving mechanical bowel preparation and standard intravenous (IV) antibiotic prophylaxis.[3]