Hydrocortisone + Neomycin Sulphate + Polymixin B

• Inflammatory Skin Disorders
• Eczema, dermatitis, psoriasis, and allergic skin reactions requiring anti-inflammatory therapy
• Bacterial Skin Infections
• Superficial infections caused by susceptible Gram-positive and Gram-negative bacteria
• Combined Inflammation and Infection
• Skin conditions where both inflammation and bacterial infection coexist
• Off-label / Clinically Accepted Uses
• Minor cuts, abrasions, insect bites with local infection risk
• Post-procedural skin irritation with secondary infection

Topical use only. Not for systemic administration.

• Adults and Children (>2 years)
• Apply a thin layer 2–3 times daily to the affected area
• Children (<2 years)
• Use only under strict medical supervision due to potential systemic absorption
• Special Populations
• Avoid large-area application in elderly, pregnant, or patients with renal/hepatic impairment
• Duration
• Limit treatment to 7–10 days unless directed by a healthcare professional

Hydrocortisone is a glucocorticoid that binds to cytoplasmic glucocorticoid receptors, modulating gene transcription to reduce pro-inflammatory cytokines, inflammatory mediators, and immune cell recruitment, producing anti-inflammatory effects. Neomycin and polymyxin B are bactericidal antibiotics: neomycin binds to bacterial ribosomal RNA, inhibiting protein synthesis in Gram-negative and some Gram-positive bacteria, while polymyxin B disrupts bacterial cell membranes, leading to cell death. The combination provides anti-inflammatory action plus broad-spectrum antibacterial coverage.

• Absorption: Minimal systemic absorption when applied topically; higher absorption over damaged skin
• Distribution: Localized effect; systemic distribution generally negligible
• Metabolism: Neomycin and polymyxin B undergo minimal metabolism; hydrocortisone metabolized hepatically
• Excretion: Hydrocortisone metabolites excreted via kidneys; neomycin and polymyxin B mostly excreted unchanged if absorbed
• Onset: Lidocaine effect within minutes; hydrocortisone effect within hours
• Half-life: Hydrocortisone ~1.5–2 hours (biologic effects longer); antibiotics half-life minimal systemically

• Pregnancy: Category C; topical use over small areas generally considered low-risk
• Lactation: Minimal systemic absorption; considered compatible with breastfeeding, but avoid applying to areas in direct infant contact

• Primary therapeutic class: Corticosteroid + Topical Antibiotics
• Subclass: Glucocorticoid (Hydrocortisone) / Aminoglycoside antibiotic (Neomycin) / Polymyxin antibiotic (Polymyxin B)

• Known hypersensitivity to hydrocortisone, neomycin, polymyxin B, or any excipients
• Viral, fungal, or mycobacterial skin infections (unless combined with appropriate therapy)
• Open or deep wounds, extensive burns without medical supervision

• High-risk patients: Infants, elderly, pregnant or breastfeeding women
• Systemic absorption risk: Avoid applying over large areas, broken skin, or prolonged use
• Nephrotoxicity / Ototoxicity: Rare risk of systemic effects from neomycin absorption, particularly in infants or compromised skin
• Skin atrophy: Prolonged corticosteroid use may cause thinning or striae
• Allergic reactions: Watch for contact dermatitis or hypersensitivity
• Avoid mucous membranes: Do not apply in eyes, mouth, or vagina unless specifically indicated

• Common
• Mild burning, stinging, or irritation at the application site
• Redness or dryness
• Less common / rare
• Skin atrophy, telangiectasia, striae with prolonged corticosteroid use
• Allergic contact dermatitis
• Rare systemic antibiotic toxicity (nephrotoxicity, ototoxicity) if absorbed

• Other topical corticosteroids or antibiotics: Additive effects or increased local/systemic absorption
• Concurrent nephrotoxic drugs: Increased risk if systemic absorption occurs
• Systemic CYP3A4 inhibitors: Minimal interaction risk, primarily for hydrocortisone if absorbed extensively

• Topical combination therapy recommended for short-term use in localized infected inflammatory skin conditions
• Emphasis on patient education regarding duration, area of application, and avoidance of prolonged use
• Updated guidelines recommend monitoring infants and high-risk patients for potential systemic absorption

• Store at 20°C to 25°C (room temperature)
• Protect from light and moisture
• Keep in a tight, well-closed container
• Do not freeze; discard if discoloration, separation, or unusual odor occurs