Comparative Pharmacology
Head-to-head clinical analysis: BRISTAGEN versus NEOMYCIN AND POLYMYXIN B SULFATES AND GRAMICIDIN.
Peer-Reviewed Evidence
Head-to-head clinical analysis: BRISTAGEN versus NEOMYCIN AND POLYMYXIN B SULFATES AND GRAMICIDIN.
BRISTAGEN vs NEOMYCIN AND POLYMYXIN B SULFATES AND GRAMICIDIN
Comparing the clinical profiles, pharmacokinetic behaviors, and safety indices of these two therapeutic agents.
Bristagen (amikacin) is an aminoglycoside antibiotic that irreversibly binds to the 30S ribosomal subunit, inhibiting bacterial protein synthesis.
Neomycin and gramicidin are aminoglycoside and polypeptide antibiotics, respectively, that inhibit bacterial protein synthesis by binding to the 30S and 50S ribosomal subunits, while polymyxin B is a cationic detergent that disrupts bacterial cell membrane integrity by binding to lipopolysaccharides.
1-2 mg/kg IM or IV every 8-12 hours; typical adult dose is 1 mg/kg every 8 hours.
1-2 drops or a small amount applied to affected eye(s) every 4 hours, or more frequently if severe, for up to 7-10 days. Ophthalmic ointment: apply a 1/2-inch ribbon into conjunctival sac every 3-4 hours.
None Documented
None Documented
2.5 hours (prolonged to 20-40 hours in renal impairment).
Neomycin: plasma half-life ~2-3 hours in patients with normal renal function, but can extend to 12-24 hours or more in renal impairment. Polymyxin B: half-life ~6 hours in normal renal function, prolonged significantly in renal failure (up to 2-3 days). Gramicidin: not systemically absorbed; half-life not applicable.
Renal (90% unchanged via glomerular filtration); biliary/fecal excretion <10%.
Neomycin and polymyxin B sulfates and gramicidin are poorly absorbed from intact skin or ophthalmic sites. After topical application, absorbed neomycin is excreted primarily unchanged in urine (30-50% of absorbed dose) via glomerular filtration; polymyxin B is excreted slowly via renal tubular secretion and glomerular filtration (60-70% of absorbed dose in urine); fecal elimination accounts for minor amounts. Gramicidin is not significantly absorbed.
Category C
Category A/B
Aminoglycoside Antibiotic
Aminoglycoside Antibiotic