April 28, 2021

DIY Cortisporin Ointment for Treatment of Inflamed Skin Infections / Lesions

Cortisporin ointment is a fantastic ointment I often prescribe for any inflamed skin lesions or skin infections involving the nose, ear, face, and neck. After all, it contains 3 different antibiotics (bacitracin, neomycin, and polymyxin B) to address any infection as well as a steroid (hydrocortisone) to help with swelling, redness, inflammation, and pain. Once upon a time, this prescription ointment was very easy to prescribe and was never on backorder. However, over the past 1-2 years, it seems to be always on backorder leading to frustration for myself as well as patients. Even if it is available, the copay for this ointment appears to have increased profoundly for some patients to as much as $75 for a small tube of it.

One could have a compound pharmacy make it for a patient, but compounds typically are not covered by insurance and can cost close to $100.

The next best thing is to use over-the-counter neosporin AND over-the-counter hydrocortisone ointment (not the cream) in an alternating fashion throughout the day or to mix a little of each on a finger before each application. Indeed, over-the-counter (OTC) neosporin contains the same 3 antibiotics as rx cortisporin (bacitracin, neomycin, and polymyxin B) and OTC hydrocortisone is the same hydrocortisone ingredient also found in rx cortisporin.

Each gram of Rx Cortisporin Ointment contains:

- neomycin 3.5mg

- polymyxin B 5000 units

- bacitracin 400 units

- hydrocortisone 10mg (1%)

Each gram of OTC neosporin (first 3) and OTC hydrocortisone (last one) contains:

- neomycin 3.5mg

- polymyxin B 10,000 units

- bacitracin 500 units

- hydrocortisone 10mg (1%)

Basically the same! In fact, one can see that the OTC neosporin actually contains MORE antibiotics than the prescription cortisporin.

However, this method of alternating applications of neosporin and hydrocortisone is less than ideal.

But wait... one can mix the two OTC ointments to basically create a product similar to the prescription cortisporin ointment. How does one go about this? Read on or watch the video here.

You need to purchase the following, all available over-the-counter or on Amazon which are linked.

- One tube of neosporin

- One tube of 1% hydrocortisone ointment

- Two 10ml luer lock syringes

- Blunt tip dispensing needle

- Luer-lock connector

- Small squeeze tube (lip gloss squeeze tubes work great)

On a throughly cleaned counter surface, squeeze about 5ml of the neosporin ointment into one 10ml luer-lock syringe. Next, squeeze about 5ml of the 1% hydrocortisone ointment into the other 10ml luer-lock syringe. 

Attach both syringes via a luer-lock connector. Now mix the contents of the two syringes by fully depressing the plunger in an alternating fashion between the two syringes. After about 20 times, it should be fully mixed and turns white in color compared to original grey. 

Attach a blunt-tip dispensing needle to the syringe and squeeze contents into a squeeze bottle

Don't forget to label the bottle and also include an expiration date that is not any longer than the expiration dates found on the OTC ointment tubes.

There you go! Do keep this away from sunlight and stored at room temperature. This ointment can only be used on skin and not in mucus membranes nor in the eyes.

Do keep in mind that although this DIY cortisporin ointment has identical active ingredients to the prescription version, the actual amounts/concentration are slightly different (DIY is a bit weaker).

Each gram of DIY vs Rx cortisporin ointment contains (assuming equal amounts are mixed):

• neomycin 1.75mg vs 3.5mg - DIY has 50% less than Rx

• polymyxin B 5000 units vs 5000 units - the same

• bacitracin 250 units vs 400 units - DIY has ~40% less than Rx

• hydrocortisone 5mg (0.5%) vs 10mg (1%) - DIY has 50% less than Rx 

As a disclaimer, what you are doing above is compounding a new medication and falls under the guidelines for section 503A of the Federal Food, Drug, and Cosmetic Act. As such, this compounding can only be done by a licensed pharmacist or physician.

Fauquier blog
Fauquier ENT

Dr. Christopher Chang is a private practice otolaryngology, head & neck surgeon specializing in the treatment of problems related to the ear, nose, and throat. Located in Warrenton, VA about 45 minutes west of Washington DC, he also provides inhalant allergy testing/treatment, hearing tests, and dispenses hearing aids.

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