Hydrocortisone/ Neomycin

Registered South African indications:

Corticosteroid-responsive dermatoses with secondary bacterial infection caused by:

• Gram-positive aerobic cocci (including Streptococci, Enterococci)
• Gram-negative aerobic bacilli (including E.coli, Proteus spp.)

Combination products may have additional pharmacological effects not accounted for by the action of the individual ingredients

Contraindications

• Hypersensitivity to active ingredient or to any of the excipients in this combination product
• Local viral infections such as herpes simplex, vaccinia, or varicella
• Should not be used in the nappy areas in infants for flexural eruptions and ideally, should not be used in infants and young children at all
• Extensive skin damage
• Pregnancy
• Lactation

Cautions

• Renal impairment
• Hepatic impairment
• Elderly
• Occlusive dressings 
• Plaque psoriasis 
• Children
• Elderly 
• Prolonged use
• Concomitant use with contact lenses

Forms avail. in SA and covered in this monograph: cre

Corticosteroid-responsive dermatoses with secondary bacterial infection caused by Gram-positive aerobic cocci (including Streptococci, Enterococci); Gram-negative aerobic bacilli (including E.coli, Proteus spp.)

Hydrocortisone/ Neomycin
10/5 (mg/g)

• Topical (cre): Apply small quantity to affected area(s), 8-24hrly

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Area should be cleaned thoroughly before application

Not recommended for use in infants and young children

Recommendations for this combination product as per highest risk category when comparing individual active ingredients

Pregnancy

• Contraindicated

Breastfeeding

• Contraindicated

Renal Impairment

• Caution; no dose adjustment recommended (Hydrocortisone)

Hepatic Impairment

• Caution; no dose adjustment recommended (Hydrocortisone)

Elderly

• Caution; dose adjustment recommended (Hydrocortisone)

Porphyria Information

• Probably not porphyrinogenic (PNP)

Combination products may have additional pharmacological effects not accounted for by the action of the individual ingredients

Hydrocortisone
Central Nervous System Disorders 

• Euphoria
• Psychological dependence
• Depression
• Insomnia
• Aggravation of schizophrenia 
• Increased intracranial pressure with papilloedema in children (pseudotumour cerebri)
• Aggravation of epilepsy

Cardiovascular Disorders 

• Bradycardia
• Cardiac arrest
• Cardiac arrhythmias
• Cardiac enlargement
• Congestive cardiac failure
• Fat embolism
• Hypertension
• Hypertrophic cardiomyopathy in premature infants
• Myocardial rupture following recent myocardial infarction 
• Pulmonary oedema
• Syncope
• Tachycardia
• Thromboembolism
• Thrombophlebitis
• Vasculitis

Gastrointestinal Disorders 

• Dyspepsia
• Peptic ulceration with perforation and haemorrhage
• Acute pancreatitis
• Candidiasis

Endocrine and Metabolic Disorders 

• Suppression of the hypothalamic-pituitary-adrenal axis
• Growth suppression (children)
• Menstrual irregularity and amenorrhoea
• Cushingoid facies
• Hirsutism
• Increased weight
• Impaired carbohydrate tolerance
• Negative protein balance 
• Negative calcium balance
• Increased appetite
• Sodium and water retention
• Hypokalaemic alkalosis

Musculoskeletal Disorders

• Osteoporosis
• Vertebral and long bone fractures
• Avascular osteonecrosis
• Tendon rupture
• Proximal myopathy

Skin and Subcutaneous Tissue Disorders 

• Impaired healing
• Pruritis
• Skin atrophy
• Striae
• Telangectasia
• Pustular acne
• Peri-oral dermatitis
• Skin depigmentation
• Dermatitis
• Eczema
• Ecchymoses

Immune, Blood and Lympathic system disorders 

• Increased susceptibility and severity of infections
• Opportunistic infections
• Recurrence of dormant tuberculosis 
• Hypersensitivity, including anaphylaxis
• Leucocytosis

Sensory Disorders 

• Increased intraocular pressure
• Glaucoma
• Papilloedema
• Posterior subcapsular cataracts
• Corneal or scleral thinning
• Exacerbation of ophthalmic viral or fungal diseases

Others 

• Flushing 

Neomycin
Central Nervous System Disorders

• Headache

Genitourinary Disorders

• Nephrotoxicity 

Immune, Blood and Lymphatic System Disorders

• Hypersensitivity 

Sensory Disorders

• Ocular discomfort 
• Keratitis 
• Eye irritation 
• Ototoxicity

No information available

None routine. Specific case may require

• Blood glucose
• Electrolytes
• Growth (children)
• Ophthalmic examination

Hydrocortisone
Hydrocortisone inhibits the release of arachadonic acid from the cell membrane and thus interferes with the initiation of the inflammatory response. It may depress the formation, release and activity of endogenous chemical mediators of inflammation.  It has anti-inflammatory, antipruritic, antiallergic and vasoconstrictive effects. 

Neomycin
Neomycin is an aminoglycoside antibiotic which acts by binding to a specific protein on the 30S ribosomal subunit of the microbe. This results in faulty alignment or recognition with respect to mRNA and probably tRNA during initiation of microbial peptide chain formation. This results in the production of non-functional peptide chains. 

COMBINATION PREPARATIONS

Neomycin/ Hydrocortisone

Cream (per g) 5mg/10mg

• Neoderm (Adcock)