Is Meikang Ointment Safe for Infants with Hearing Loss?

Regarding the ototoxicity of Meikang ointment?

Hello, pharmacist.
My daughter is currently six months old and has a red ring around her anus.
The doctor prescribed Meikang ointment to apply to the affected area.
However, since my daughter has congenital hearing loss, a previous doctor advised us to avoid using ototoxic medications to prevent hearing damage.
I would like to ask the pharmacist if applying Meikang ointment to the anus could cause ototoxicity and if we should discontinue its use.
Thank you for your response.
(I found information online stating that Meikang ointment has ototoxic side effects.)

Wei Xi, 30~39 year old female. Ask Date: 2018/09/22

Dr. Hou Fangmin reply Pharmacology

Dear Mr.
Wei Xi,
Every parent worries about their child's health.
The Meikang ointment contains Triamcinolone acetonide (1.0 mg, a corticosteroid), Neomycin (2.5 mg, an antibiotic), and Gramicidin (0.25 mg, an antibiotic).
As for ear drops, applying them directly into the ear can cause the most harm to the auditory nerve.
However, since your child is using the ointment topically on the affected area, the dosage is considered mild, and it is not being used long-term, so the absorption should be minimal.
If the condition improves, there is no need to continue using it.
Lastly, I wish your child a happy and healthy growth.

Reply Date: 2018/09/22

More Info

When it comes to the safety of using Meikang Ointment (which contains Triamcinolone acetonide, Neomycin, and Gramicidin) on an infant with congenital hearing loss, there are several important considerations to keep in mind.

First, it’s essential to understand the components of Meikang Ointment. Triamcinolone acetonide is a corticosteroid that helps reduce inflammation, while Neomycin and Gramicidin are antibiotics used to prevent or treat infections. The concern regarding ear toxicity primarily arises from the use of Neomycin, which is known to have ototoxic effects, particularly when used inappropriately or in high concentrations.

In the case of your infant, who is six months old and has been prescribed this ointment for a red area around the anus, the application method is crucial. Since the ointment is intended for topical use on the skin and not for direct application in or around the ears, the risk of ototoxicity is significantly reduced. The absorption of Neomycin through the skin is minimal compared to direct application into the ear canal, which is where the greatest risk of hearing damage occurs.

Moreover, the concern about ototoxicity is primarily relevant when medications are administered in a manner that allows them to enter the inner ear or when they are used in high doses over extended periods. In your case, since the ointment is being applied to a localized area (the anal region) and not being ingested or applied near the ears, the likelihood of causing harm to your child’s hearing is low.

However, it is always prudent to monitor your child for any unusual symptoms or reactions after applying the ointment. If you notice any signs of irritation, allergic reactions, or changes in hearing, it would be wise to consult your pediatrician or a specialist in pediatric otolaryngology (ear, nose, and throat) for further evaluation.

In summary, while Meikang Ointment contains Neomycin, the risk of ear toxicity when applied topically to the skin is minimal. It is essential to follow the prescribed usage and avoid applying the ointment near the ears. If you have any lingering concerns or if your child has a history of severe reactions to medications, it is always best to discuss these with your healthcare provider to ensure the safest course of action for your child's health.

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