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Drug Details

NEO-CORTEF

• Drug Class Description
  Antibiotics (aminoglycosides) / corticosteroids (steroids).
• Generic Name
  Neomycin sulphate, hydrocortisone acetate ear drops October 2000: Dominion expects Neo- Cortef ear drops and ear ointment to be out of stock until spring 2001. The company says that it is having difficulties obtaining the raw material sterile hydrocortis
• Presentation
  Eye/Ear Drops Eye/Ear Ointment
• Description
  Eye/Ear Drops: Hydrocortisone acetate 15 mg and neomycin sulphate 5 mg (equivalent to neomycin 3.5 mg) per ml. Eye/Ear Ointment: Hydrocortisone acetate 15 mg and neomycin sulphate 5 mg (equivalent to neomycin 3.5 mg) per g.
• Indications
  

  Eye: Short-term treatment of steroid responsive conditions of the eye when prophylactic antibiotic treatment is also required, after excluding the presence of fungal and viral disease.

  Eyelid: Blepharitis

  Ear: Otitis externa caused by susceptible organisms

• Adult Dosage
  

  Adults and Children:

  Drops:

  Eye: One or two drops to be applied to each eye up to six times daily or more frequently if required.

  Ear: Two or three drops to be instilled into the ear three to four times daily.

  Ointment:

  Eye: Apply sparingly two or three times daily, or at night if drop treatment is given during the day.

  Ear: Apply once or twice daily.

  Elderly patients:

  There is no information to suggest that a change in dosage is warranted in the elderly, however care should be taken when the drops/ointment are administered in this group (see special warnings and special precautions for use).

  Do not exceed the recommended dose.

• Contra Indications
  

  Viral, fungal, tuberculous or purulent conditions of the eye. Use is contra-indicated if glaucoma is present or herpetic keratitis (eg dendritic ulcer) is considered a possibility.

  Use of topical steroids in the latter condition can lead to extension of the ulcer and marked visual deterioration.

  Otitis externa should not be treated when the eardrum is perforated because of the risk of ototoxicity.

  Hypersensitivity to any of the ingredients of the preparation.

• Special Precautions
  

  Topical corticosteroids should never be given for an undiagnosed red eye as inappropriate use is potentially blinding.

  Treatment with corticosteroid/antibiotic combinations should not be continued for more than 7 days in the absence of any clinical improvement, since prolonged use may lead to occult extension of infection due to the masking effect of the steroid. Prolonged use may also lead to skin sensitisation and the emergence of resistant organisms.

  Prolonged use may lead to the risk of adrenal suppression in infants.

  Treatment with corticosteroid preparations should not be repeated or prolonged without regular review to exclude raised intra-ocular pressure, cataract formation or unsuspected infections.

  Aminoglycoside antibiotics may cause irreversible, partial or total deafness when given systemically or when applied topically to open wounds or damaged skin. This effect is dose related and is enhanced by renal or hepatic impairment. Although this effect has not been reported following topical ocular use, the possibility should be considered when high dose topical treatment is given to small children or infants and patients suffering from renal impairment.

  Care should also be taken when the drops/ointment are administered to the elderly and those with existing hearing loss.

• Interactions
  

  None relevant to ocular/aural use.

• Adverse Drug Reactions
  

  Hypersensitivity reactions, usually of the delayed type, may occur leading to irritation, burning, stinging, itching and dermatitis.

  Topical steroid use may result in increased intra-ocular pressure leading to optic nerve damage, reduced visual acuity, and visual field defects.

  Intensive or prolonged use of topical corticosteroids may lead to formation of posterior subcapsular cataracts.

  In those diseases causing thinning of the cornea or sclera, corticosteroid therapy may result in thinning of the globe leading to perforation.