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Home > Living Well > Health Library > Neomycin-Bacitracin-Poly-HC
Neomycin can decrease absorption or increase elimination of many nutrients, including calcium, carbohydrates, beta-carotene, fats, folic acid, iron, magnesium, potassium, sodium, and vitamin A, vitamin B12, vitamin D, and vitamin K. Surgery preparation with oral neomycin is unlikely to lead to deficiencies. It makes sense for people taking neomycin for more than a few days to also take a multivitamin-mineral supplement.
Tetracycline can interfere with the activity of folic acid, potassium, and vitamin B2, vitamin B6, vitamin B12, vitamin C, and vitamin K. This is generally not a problem when taking tetracycline for two weeks or less. People taking tetracycline for longer than two weeks should ask their doctor about vitamin and mineral supplementation. Taking 500 mg vitamin C simultaneously with tetracycline was shown to increase blood levels of tetracycline in one study. The importance of this interaction is unknown.
Several cases of excessive bleeding have been reported in people who take antibiotics. This side effect may be the result of reduced vitamin K activity and/or reduced vitamin K production by bacteria in the colon. One study showed that people who had taken broad-spectrum antibiotics had lower liver concentrations of vitamin K2 (menaquinone), though vitamin K1 (phylloquinone) levels remained normal. Several antibiotics appear to exert a strong effect on vitamin K activity, while others may not have any effect. Therefore, one should refer to a specific antibiotic for information on whether it interacts with vitamin K. Doctors of natural medicine sometimes recommend vitamin K supplementation to people taking antibiotics. Additional research is needed to determine whether the amount of vitamin K1 found in some multivitamins is sufficient to prevent antibiotic-induced bleeding. Moreover, most multivitamins do not contain vitamin K.
Preliminary data suggest that corticosteroid treatment increases chromium loss. Double-blind trials are needed to confirm these observations.
Oral corticosteroids reduce absorption of calcium and interfere with the activation and metabolism of the vitamin, increasing the risk of bone loss. Doctors can measure levels of activated vitamin D (called 1,25 dihydroxycholecalciferol) to determine whether a deficiency exists; if so, activated vitamin D is only available by prescription. A study of rheumatoid arthritis patients treated with low amounts of prednisone found that those who received 1,000 mg of calcium per day plus 500 IU of vitamin D per day for two years experienced no bone loss during that time period. An analysis of properly conducted trials concluded that supplementation with vitamin D and calcium was more effective than placebo or calcium alone in protecting against corticosteroid-induced osteoporosis. Most doctors recommend 1,000 mg of calcium and 400–800 IU vitamin D per day for the prevention of osteoporosis.
Preliminary data suggest that supplementation with chromium (600 mcg per day in the form of chromium picolinate) may prevent corticosteroid-induced diabetes. Double-blind trials are needed to confirm these observations.
A common side effect of antibiotics is diarrhea, which may be caused by the elimination of beneficial bacteria normally found in the colon. Controlled studies have shown that taking probiotic microorganisms—such as Lactobacillus casei, Lactobacillus acidophilus, Bifidobacterium longum, or Saccharomyces boulardii—helps prevent antibiotic-induced diarrhea.
The diarrhea experienced by some people who take antibiotics also might be due to an overgrowth of the bacterium Clostridium difficile, which causes a disease known as pseudomembranous colitis. Controlled studies have shown that supplementation with harmless yeast—such as Saccharomyces boulardii or Saccharomyces cerevisiae (baker’s or brewer’s yeast)—helps prevent recurrence of this infection.
Treatment with antibiotics also commonly leads to an overgrowth of yeast (Candida albicans) in the vagina (candida vaginitis) and the intestines (sometimes referred to as “dysbiosis”). Controlled studies have shown that Lactobacillus acidophilus might prevent candida vaginitis.
Tooth discoloration is a side effect of minocycline observed primarily in young children, but it may occur in adults as well. Vitamin C supplementation may prevent staining in adults taking minocycline.
The diarrhea experienced by some people who take antibiotics also might be due to an overgrowth of the bacterium Clostridium difficile, which causes a disease known as pseudomembranous colitis. Controlled studies have shown that supplementation with harmless yeast—such as Saccharomyces boulardii or Saccharomyces cerevisiae (baker’s or brewer’s yeast)—helps prevent recurrence of this infection. In one study, taking 500 mg of Saccharomyces boulardii twice daily enhanced the effectiveness of the antibiotic vancomycin in preventing recurrent clostridium infection. Therefore, people taking antibiotics who later develop diarrhea might benefit from supplementing with saccharomyces organisms.
When taken with amoxicillin, bromelain was shown to increase absorption of amoxicillin in humans. When 80 mg of bromelain was taken together with amoxicillin and tetracycline, blood levels of both drugs increased, though how bromelain acts on drug metabolism remains unknown. An older report found bromelain also increased the actions of other antibiotics, including penicillin, chloramphenicol, and erythromycin, in treating a variety of infections. In that trial, 22 out of 23 people who had previously not responded to these antibiotics did so after adding bromelain taken four times per day.
Doctors will sometimes prescribe enough bromelain to equal 2,400 gelatin dissolving units (listed as GDU on labels) per day. This amount would equal approximately 3,600 MCU (milk clotting units), another common measure of bromelain activity.
When applied to the skin, glycyrrhetinic acid (a chemical found in licorice (Glycyrrhiza glabra)) increases the activity of hydrocortisone. This effect might allow for less hydrocortisone to be used when combined with glycyrrhetinic acid, but further study is needed to test this possibility.
Children with alopecia areata who supplemented 100 mg of zinc and 20 mg biotin each day, combined with topical clobetasol, showed more improvement compared to children who took oral corticosteroid drugs. Controlled research is needed to determine whether adding oral zinc and biotin to topical clobetasol therapy is more effective than clobetasol alone. However, until more information is available, caregivers should consider that children with alopecia who are currently taking oral corticosteroids might benefit from switching to supplements of zinc and biotin along with topical clobetasol.
Khat (Catha edulis) is an herb found in East Africa and Yemen that has recently been imported into the United States. Studies have shown that chewing khat significantly reduces the absorption of ampicillin, which might reduce the effectiveness of the antibiotic. Therefore, people taking ampicillin should avoid herbal products that contain khat.
Taking calcium, iron, magnesium, or zinc at the same time as minocycline can decrease the absorption of both the drug and the mineral. Therefore, calcium, iron, magnesium, or zinc supplements, if used, should be taken an hour before or after the drug.
Berberine is a chemical extracted from goldenseal (Hydrastis canadensis),barberry (Berberis vulgaris), and Oregon grape (Berberis aquifolium), which has antibacterial activity. However, one double-blind study found that 100 mg berberine given with tetracycline (a drug closely related to doxycycline) reduced the efficacy of tetracycline in people with cholera. In that trial, berberine may have decreased tetracycline absorption. Another double-blind trial found that berberine neither improved nor interfered with tetracycline effectiveness in cholera patients. Therefore, it remains unclear whether a significant interaction between berberine-containing herbs and doxycycline and related drugs exists.
Licorice (Glycyrrhiza glabra) extract was shown to decrease the elimination of prednisone in test tube studies. If this action happens in people, it might prolong prednisone activity and possibly increase prednisone-related side effects. A small, controlled study found that intravenous (iv) glycyrrhizin (an active constituent in licorice) given with iv prednisolone prolonged prednisolone action in healthy men. Whether this effect would occur with oral corticosteroids and licorice supplements is unknown.
An animal study has shown that glycyrrhizin prevents the immune-suppressing actions of cortisone—the natural corticosteroid hormone produced by the body. More research is necessary to determine if this action is significant in humans taking oral corticosteroids. Until more is known, people should not take licorice with corticosteroids without first consulting a doctor.
In animal research, applying aloe (Aloe vera) gel topically along with a topical corticosteroid enhanced the hormone’s anti-inflammatory activity in the skin. No human research has investigated this effect.
Corticosteroids may increase the body’s loss of magnesium. Some doctors recommend that people taking corticosteroids for more than two weeks supplement with 300–400 mg of magnesium per day. Magnesium has also been reported to interfere with the absorption of dexamethasone.
Several cases of excessive bleeding have been reported in people who take antibiotics. This side effect may result the killing of vitamin K–producing bacteria in the intenstines by the antibiotic. Risk factors for developing antibiotic-induced bleeding include being malnourished or having little or no oral intake (as in people undegoing major surgery or being treated in an intensive care unit). Infants may also be at increased risk, since vitamin K status in the first few months of life is often low. Little is known about which antibiotics do and do not promote vitamin K deficiency. People taking an antibiotic should discuss with their doctor the advisability of taking vitamin K.
Last Review: 03-24-2015
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