Maxitrol(1 mg+3500 IU+6000 IU)/ml

Maxitrol is a fixed-dose combination of a corticosteroid (dexamethasone) with two antibiotics (neomycin sulphate and polymyxin B sulphate), formulated as an ophthalmic (and in some markets otic) preparation. It is used when steroid-responsive inflammation is present together with a risk of, or existing, susceptible superficial bacterial infection.

Established / approved uses

• Steroid-responsive inflammatory conditions of the eye — inflammation of the palpebral and bulbar conjunctiva, cornea, and anterior segment of the globe (e.g. allergic conjunctivitis, phlyctenular keratoconjunctivitis, iritis, cyclitis) — where a bacterial infection or risk of bacterial infection exists.
• Chronic anterior uveitis and corneal injury from chemical, radiation, or thermal burns, or penetration of foreign bodies, when infection risk justifies antibiotic cover.
• Superficial bacterial infections of the external ear canal (otitis externa) with associated inflammation, in markets where an otic formulation is available, provided the eardrum is intact.

Notes on evidence strength

• The antimicrobial components provide coverage against common susceptible organisms such as Staphylococcus aureus and Pseudomonas aeruginosa, but do not reliably cover streptococcal species — it is not appropriate as monotherapy for infections known or suspected to involve streptococci.
• Maxitrol is an adjunct/combination therapy by design: the corticosteroid controls inflammation while the antibiotics reduce infection risk; it is not intended for infections without an inflammatory component that would benefit from steroid use.
• It is not indicated, and should not be used, for infections due to viruses, fungi, or mycobacteria (see Contraindications).

Each mL of Dexamethasone + Neomycin Sulphate + Polymyxin B Sulphate ophthalmic suspension/solution typically contains:

• Dexamethasone 0.1% w/v
• Neomycin sulphate equivalent to approximately 0.35% w/v neomycin base
• Polymyxin B sulphate approximately 10,000 units/mL

Exact strengths and the vehicle/excipients (e.g. benzalkonium chloride as preservative, suspending agents) vary by brand and formulation (drop, ointment, or otic preparation); always check the product label of the dispensed brand.

Maxitrol is a multi-ingredient anti-inflammatory and anti-infective preparation combining a synthetic corticosteroid with two antibiotics that act against different bacterial targets. Dexamethasone suppresses the inflammatory response (reducing redness, swelling, and discomfort), while neomycin sulphate (an aminoglycoside) and polymyxin B sulphate (a polypeptide antibiotic) together provide broad coverage against common gram-positive and gram-negative bacteria, including Pseudomonas aeruginosa.

It is most commonly supplied as a sterile ophthalmic suspension, solution, or ointment for eye use, and in some markets as an otic (ear) preparation. It is a prescription-only medicine intended for short-term, physician-supervised use.

Maxitrol belongs to the therapeutic class of ophthalmic/otic corticosteroid – antibiotic combinations, used for the combined anti-inflammatory and anti-infective management of eye and ear conditions.

Dexamethasone + Neomycin Sulphate + Polymyxin B Sulphate combines three active ingredients with complementary mechanisms:

• Dexamethasone is a potent synthetic glucocorticoid that diffuses into cells, binds glucocorticoid receptors, and suppresses the inflammatory cascade — reducing capillary dilation, leukocyte migration, fibrin deposition, and scar formation. It also inhibits phospholipase A2, reducing prostaglandin and leukotriene synthesis.
• Neomycin sulphate is an aminoglycoside antibiotic that binds the bacterial 30S ribosomal subunit, causing misreading of mRNA and inhibition of protein synthesis; it is bactericidal against many gram-positive and gram-negative organisms.
• Polymyxin B sulphate is a cationic polypeptide antibiotic that binds bacterial cell membrane phospholipids, disrupting membrane integrity and causing leakage of cell contents; it is particularly active against gram-negative organisms including Pseudomonas aeruginosa.

Following topical ophthalmic or otic application, systemic absorption is generally low, but can increase with prolonged use, high dosing frequency, or when applied to damaged epithelium (e.g. corneal/tympanic membrane defects), raising the risk of systemic and local adverse effects.

• Wash hands before use. Avoid letting the dropper or tube tip touch the eye, eyelid, ear, fingers, or any other surface, to prevent contamination.
• For eye use: tilt the head back, gently pull down the lower eyelid to form a pocket, instill the prescribed number of drops (or ointment), then close the eye gently for 1–2 minutes. Apply light pressure at the inner corner of the eye to reduce systemic absorption.
• If using more than one eye medication, wait at least 5 minutes between different products.
• Remove soft contact lenses before applying Maxitrol and wait as advised by your physician before reinserting them.
• For ear use: tilt the head sideways or lie down with the affected ear up, instill the drops, and keep the head tilted for a few minutes to allow the medicine to reach the ear canal.
• Do not use Maxitrol for longer than prescribed, and return for follow-up as advised, especially if used for 10 days or more.

Formal drug–drug interaction studies with Maxitrol are limited because systemic absorption from topical ophthalmic/otic use is normally low; however, the following clinically relevant points apply:

• Other topical or systemic corticosteroids: concurrent use may compound corticosteroid-related ocular effects (raised intraocular pressure, cataract risk) — avoid unnecessary duplication.
• Other ototoxic or nephrotoxic drugs (e.g. systemic aminoglycosides, loop diuretics): if significant systemic absorption of neomycin occurs (for example through a perforated eardrum or damaged skin/cornea), additive ototoxicity or nephrotoxicity is theoretically possible — use with caution.
• Other topical ophthalmic/otic products: using multiple topical products together can dilute or wash out each other’s effect; space administration of different products apart as advised.

Side effects of Maxitrol are usually local and related to either the corticosteroid or antibiotic components:

• Common: transient burning, stinging, or itching on application; blurred vision immediately after use.
• Hypersensitivity/allergic reactions: neomycin is a recognised cause of contact/cutaneous sensitization — itching, redness, swelling of the eyelids, or worsening irritation may indicate an allergic reaction requiring the medicine to be stopped.
• With prolonged use (corticosteroid-related): raised intraocular pressure/glaucoma, posterior subcapsular cataract formation, delayed wound/epithelial healing, thinning and possible perforation of the cornea or sclera, secondary ocular infection (bacterial, fungal, or viral) due to masking or exacerbating existing infection, and optic nerve damage.
• Rare: ototoxicity (hearing disturbance) or nephrotoxicity if substantial systemic absorption of neomycin occurs, most relevant when used in the ear with a perforated eardrum or on extensive denuded skin.

Pregnancy: Corticosteroids such as the dexamethasone component of Maxitrol have been associated with fetal effects in animal studies when given systemically at high doses; data specific to topical ophthalmic/otic use in human pregnancy are limited. Maxitrol should be used in pregnancy only if clearly needed and the potential benefit justifies the potential risk to the fetus — consult a physician before use.

Lactation: It is not known whether topically applied dexamethasone, neomycin, or polymyxin B are excreted in human breast milk in clinically significant amounts. Caution is advised, and a physician should be consulted before using Maxitrol while breastfeeding.

• Not for injection. Maxitrol is for topical ophthalmic or otic use only.
• Prolonged use (10 days or more) requires monitoring of intraocular pressure by a physician because of the risk of steroid-induced glaucoma and optic nerve damage.
• Long-term corticosteroid use can cause posterior subcapsular cataracts, delay healing, and increase susceptibility to secondary ocular infection, including fungal infection following prolonged use — fungal infection should be suspected in any persistent corneal ulceration despite treatment.
• Use with caution in conditions causing corneal or scleral thinning, as perforation has been reported with corticosteroid use.
• Neomycin carries a recognised risk of cutaneous/contact sensitization; discontinue if signs of hypersensitivity develop.
• For otic use, avoid if the tympanic membrane is perforated unless specifically directed by a physician, due to the risk of ototoxicity.
• Maxitrol is not intended for prolonged, unsupervised self-use; regular physician follow-up is required, and it should not be continued beyond the prescribed course.
• Antibiotic stewardship: Take/use Maxitrol exactly as prescribed by your physician; do not stop, extend, skip doses, or share this medicine with others without medical advice, to reduce the risk of antibiotic resistance and treatment failure.

Topical ophthalmic or otic overdose of Maxitrol (e.g. excessive drops used at one time) is unlikely to cause serious systemic toxicity but may increase local side effects such as irritation, redness, or increased intraocular pressure with repeated excess use. If a significantly larger amount than prescribed is used, or if the product is swallowed accidentally, seek immediate medical attention or contact a poison control centre rather than attempting home treatment. If the medicine is accidentally splashed in the eye in excess, rinse the eye gently with clean water and contact a physician.

Store upright at controlled room temperature, between 8°C and 27°C (46°F–80°F), protected from light. Do not freeze. Discard any unused portion as advised on the label after opening (typically within 4 weeks). Keep out of reach of children.

• Pediatric patients: Safety and efficacy of Maxitrol in children below 2 years of age have not been established. In older children, use only under close physician supervision at the lowest effective dose and shortest duration.
• Elderly: No specific dose adjustment is established; use with the same precautions as in adults, with attention to pre-existing eye conditions such as glaucoma or cataract.
• Renal/hepatic impairment: Because systemic absorption after topical ophthalmic/otic use is normally minimal, no formal dose adjustment is established; caution is still advised with prolonged or extensive application.
• Contact lens wearers: Remove lenses before application; do not reinsert until advised by a physician.

Maxitrol is intended for short-term use. Many prescribers limit an initial course to no more than 20 mL (or the equivalent smallest available pack) without re-evaluation, and treatment is generally not continued beyond 7–10 days without physician review, particularly because of the risk of raised intraocular pressure and other steroid-related complications with longer use. The exact duration should be determined by the treating physician based on response and follow-up findings.

Dexamethasone + Neomycin Sulphate + Polymyxin B Sulphate acts through three complementary mechanisms: dexamethasone suppresses inflammation by inhibiting the inflammatory cascade at multiple points (reducing vascular permeability, leukocyte infiltration, and mediator release); neomycin sulphate inhibits bacterial protein synthesis by binding the 30S ribosomal subunit; and polymyxin B sulphate disrupts the bacterial cell membrane of gram-negative organisms, causing leakage of intracellular contents and bacterial death. Together, this reduces inflammation while covering common bacterial pathogens that could otherwise proliferate under corticosteroid-induced immune suppression at the site of application.

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The safety and effectiveness of Maxitrol in pediatric patients below 2 years of age have not been established, and it should not be used in this age group except on specific physician direction. In children 2 years and older, Maxitrol may be used under close physician supervision, following the same instillation technique as in adults but for the shortest effective duration, with attention to signs of hypersensitivity, raised intraocular pressure, or ototoxicity (if used in the ear). Parents/caregivers should be counselled on proper administration technique to avoid contamination and systemic absorption.