betamethasone sodium phosphate + neomycin: clinical use

Prescribing considerations

• Confirm the diagnosis and need for both corticosteroid treatment and antibacterial cover.
• Do not use topical corticosteroids for an undiagnosed red eye.
• Reassess promptly if symptoms do not improve or worsen.
• Avoid repeated or prolonged ophthalmic treatment without specialist review.
• Consider aminoglycoside ototoxicity risk with known mitochondrial mutations or a maternal history of deafness.
• Use nasally with caution in untreated infection, pulmonary tuberculosis or recent unhealed nasal surgery.

Contraindications and cautions

• Hypersensitivity to an active ingredient or excipient
• Viral, fungal, tuberculous or purulent eye disease
• Fungal infection of the ear or nose
• Glaucoma or suspected herpetic keratitis
• Perforated tympanic membrane
• Use as eye drops while wearing soft contact lenses

Monitoring

• With repeated or prolonged ophthalmic use, assess intraocular pressure, cataract formation and occult infection.
• Investigate persistent blurred vision or other visual disturbance, with ophthalmology referral where appropriate.
• Monitor growth in children receiving prolonged nasal treatment.
• Watch for sensitisation, resistant organisms and systemic corticosteroid effects with intensive or prolonged exposure.

Clinical pharmacology

Betamethasone suppresses local inflammatory and immune responses. Neomycin provides antibacterial cover; aminoglycosides can cause ototoxicity when sufficient exposure reaches susceptible auditory tissues.

Formulation and product differences

• The product is a multidose solution licensed for the eye, ear and nose.
• It contains benzalkonium chloride, which can irritate the eye or nose and is incompatible with soft contact lenses during eye treatment.
• It contains phosphates; very rare corneal calcium deposits have occurred in patients with severely damaged corneas.
• Protect the bottle from light, do not freeze it and follow the product leaflet for disposal after opening.