Maxitrol (Neomycin Sulfate, Polymyxin B Sulfate, Dexamethasone)

Maxitrol combines antibiotic and anti‑inflammatory actions to manage ocular bacterial infections and related inflammation.

• Bacterial conjunctivitis: reduces bacterial load and resolves infection.
• Ocular inflammation: decreases swelling, redness and discomfort.
• Post‑operative inflammation: controls inflammation after eye surgery and promotes healing.
• Keratitis: treats bacterial keratitis and limits corneal damage.

• Neomycin sulfate interferes with bacterial protein synthesis by binding to the 30‑S ribosomal subunit, while Polymyxin B sulfate disrupts the bacterial cell membrane, leading to rapid cell death. Dexamethasone, a potent glucocorticoid, binds cytoplasmic glucocorticoid receptors, modulating gene transcription to suppress pro‑inflammatory cytokines, reduce vascular permeability and inhibit leukocyte migration, thereby providing anti‑inflammatory effects in ocular tissues.

Topical administration of Maxitrol may be associated with ocular and systemic adverse reactions.

Common Side Effects

• Burning or stinging sensation: transient discomfort upon instillation.
• Blurred vision: temporary visual disturbance that resolves after blinking.
• Itching or redness: mild irritation of the conjunctiva.
• Increased intra‑ocular pressure: mild rise detectable on routine check.

Serious or Rare Side Effects

• Allergic reaction: swelling, rash or hives requiring discontinuation.
• Corneal ulceration: worsening of corneal integrity necessitating urgent care.
• Secondary ocular infection: overgrowth of non‑susceptible organisms.
• Glaucoma or cataract formation: prolonged steroid exposure may accelerate these conditions.

Before prescribing Maxitrol, clinicians should consider several safety measures.

• Hypersensitivity: avoid use in patients with known allergy to neomycin, polymyxin B, dexamethasone or any excipients.
• Viral infections: do not use for viral conjunctivitis such as adenovirus, as steroids may worsen infection.
• Intra‑ocular pressure: monitor pressure during prolonged therapy, especially in glaucoma patients.
• Contact lens wear: discontinue lenses before and after instillation to prevent irritation.
• Pregnancy and lactation: safety not established; use only if benefit outweighs risk.
• Store at room temperature: keep in original container, protect from light and moisture.

Maxitrol may interact with other ophthalmic or systemic agents.

Major Interactions (Avoid)

• Concurrent ophthalmic corticosteroids: additive risk of elevated intra‑ocular pressure and cataract.
• Use with contact lenses: may cause lens contamination and irritation.
• Systemic aminoglycosides: potential additive nephrotoxicity if systemic absorption occurs (rare).

Moderate Interactions (Monitor Closely)

• Topical non‑steroidal anti‑inflammatory drugs (NSAIDs): increased risk of corneal melting.
• Other topical antibiotics: possible antagonistic effect reducing efficacy.
• Systemic immunosuppressants: may diminish infection control, requiring closer observation.