Polymyxin B + Neomycin + Hydrocortisone Pharmacology
Polymyxin B + Neomycin + Hydrocortisone
Polymyxin B
2.Nystagmus
3.Flushing
4.Nausea
5.vomiting
6.Diarrhoea
7.Rash
8.Partial deafness
9. Pruritis
10.Ataxia
11.Vertigo
12.Nephrotoxicity
13.Disturbances of vision
2.Renal dysfunction
2.Urinary tract infection
3.Burns
4.Enteric infection
Non-depolarising muscle relaxants: Neuromuscular blockade may be enhanced.
Children (IV) dose: 20000 - 40000 units/kg body weight/day in divided dose.
Neomycin
Distribution- Rapidly distributed in the body after oral administration. 30% bound to the plasma proteins. It crosses the placenta
Metabolism- Not metabolized
Excretion- Excreted through urine and feces (primarily as unchanged form). It also excreted through breast milk
2. Diarrhoea
3. Inflammation of the large intestine (colitis)
4. Nausea
5. Vomiting
6. Ototoxicity
7. Damage to the kidneys
8. Damage to vestibular function within the ear
2. Hypersensitivity to other amino glycosides
3. Intestinal obstruction
2. Neuromuscular disorder
3. Ulcerative bowel lesions
4. Extensive dermatologic conditions
5. Any other eye infection or condition
6. Glaucoma
7. Cataract surgery
8. Blockage of the bowel
9. Eighth-cranial-nerve disease (loss of hearing and/or balance)
10. Kidney disease
11. Myasthenia gravis
12. Parkinson`s disease
13. Ulcers of the bowel
2. Preventing infection following surgery
3. Topical infections
4. Systemic infections
Adults-
1 or 2 drops every three or four hours- For eye infection
Oral (solution, tablets):
Adults and teenagers-
1 to 3 grams every six hours for five or six days- coma from liver disease
Adults and teenagers-
1 gram every hour for four hours, then 1 gram every four hours for the rest of a twenty-four hour period; or 1 gram nineteen hours before surgery, 1 gram eighteen hours before surgery, and 1 gram nine hours before surgery- cleaning the bowel before surgery.
Children-
14.7 milligrams mg/kg or 6.7 mg/ pound every four hours for three days
Ear preparation:
Adults and children-
2 to 5 drops into ear canal 3 to 4 times daily for 7 to 10 days- External ear canal infection
Hydrocortisone
The drug exerts anti-inflammatory and immunosuppressant actions as follows: - 1) Induce lipocortins in macrophages, endothelium, and fibroblasts which inhibits phospholipase A2 and thus decreases the production of Prostaglandins, leukotriens (LT), and platelet activating factor, 2) Causes negative regulation of genes for cytokines in macrophages, endothelial cells and lymphocytes and thus decreases the production of interleukins (IL-1, IL-2, IL-3, IL-6), TNF-alpha, GM-CSF (granulocyte macrophage colony stimulating factor), Gama interferon and suppresses fibroblast proliferation and T-lymphocyte functions and interferes chemo taxis. 3) Decreases the production of acute phase reactants from macrophages and endothelial cells and interferes complement function. 4) Decreases the production of ELAM-1(Endothelial leukocyte adhesion molecule-1) and ICAM-1(intracellular adhesion molecule-1) in endothelial cells. 5) Inhibit IgE mediated histamine and LT-C4 release from basophiles and the effects of antigen-antibody reaction is not mediated 6) Reduces the production of collagenase and stromolysin and thus prevents tissue destruction.
Distribution: After topical application distributed throughout the local skin layers. Any drug absorbed in to circulation is rapidly removed from blood and distributed in to muscle, liver, kidney, skin, and intestine. Metabolism: Metabolized primarily in skin after topical application and a small amount absorbed in to circulation is metabolized in liver. Excretion: Metabolites are excreted mainly through urine and a small amount is excreted through faeces.
2. Irritation
3. Pruritus
4. Dryness
5. Erythema
6. Folliculitis
7. Hypertrichosis
8. Acneiform eruptions
9. Allergic contact dermatitis
10. Secondary infections
11. Atrophy
12. Striae
13. Suppression of adrenocorticotropic hormone
14. Cushing`s syndrome
15. Glucosuria
16. Hyperglycaemia
17. Fluid retention
18. Sodium retention
19. Hypokalaemia
20. Oedema
21. Weakness
22. Muscle wasting
23. Gastrointestinal discomfort
24. Peptic ulcer
25. Haemorrhage
26. Joint damage
27. Fibrosis
28. Headache
29. Convulsions
30. Vertigo
31. Increased intracranial pressure
32. Depression
33. Local hypopigmentation
2. Not to be given I.V. or I.M.
3. Local or systemic infections
4. Fungal or herpetic keratitis
5. Cataract
6. Tubercular or syphilitic lesions.
2. Use of potent preparations should be short term or intermittent
3. Milder drugs should be used in acute lesions and stronger ones are for chronic lesions
4. Avoid sudden discontinuation of the drug
5. Hypothyroidism
6. Cirrhosis
7. Stress
8. Sepsis
9. Ocular herpes simplex
10. Peptic ulcer
11. Hypertension
12. Osteoporosis
13. Myasthenia gravis
14. Renal impairment
15. Ulcerative colitis
16. Diverticulitis
NEONATES : Contraindicated
1. Rheumatoid arthritis
2. Gouty arthritis
3. Osteoarthritis
4. Joint sequelae of fractures and dislocations
5. Other inflammatory conditions of joints.
Periarticular or soft tissue injections:
1. Bursitis
2. Synovitis
3. Tendinitis
4. Taenosinovitis
5. Cystic tumors of tendon or aponeurosis
6. Epicondylitis
7. Scapulo-humeral periarthritis
8. Periarthritis of hip
9. Tarsalgias
10. Meta-tarsalgias
11. Dupuytren`s contracture
12. Peyronie`s disease.
Intra-lesional injections:
1. Tubal stenosis in gynaecology
2. Dermatological lesions
3. Keloids
4. Hypertrophic scars
5. Localized hypertrophies
6. Inflammatory lesions of lichen
7. Lichen simplex chronicus
8. Granuloma annulare
9. Alopecia areata
10. Necrobiosis lipoidica diabeticorum
11. Discoid lupus erythematosus
12. Psoriatic plaques
Intra-thecal or epidural injections:
1. Lumbago
2. Cervico-brachial neuralgia
3. Sciatica
4. Other painful radiculopathies
5. Multiple sclerosis
6. Tuberculous meningitis.
Apply 0.5% to 2.5% 1 to 4 times daily as required.
Ointment:
0.5% to 2.5% Apply 1 to 4 times as required.
Lotion:
0.5% to 2.5% Apply 1 to 4 times as required.
Intra-articular, Intra-dermal, Intra-pleural injection:
5 to 50mg depending up on the size of the joint and severity of the condition.
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