Amikacin/Neomycin/Polymyxin B clEARmix Thermo Gel Otic (3mL Syringe)

How to Use clEARmix Thermo Gel Otic (Ear Medication)

This is a liquid ear medication that turns into a gel once it warms up in your pet’s ear, helping it stay in place and work effectively. It comes in a soft-tipped syringe for easy use.

Step-by-Step:

1. Keep it cool – Store in the fridge if instructed. Before using, hold the syringe in your hands for a minute so it’s not too cold, but don’t warm it too much.
2. Get your pet ready – Have them sit comfortably and gently lift the ear flap. A second person can help hold them still if needed.
3. Clean the ear (if advised) – Use a vet-approved ear cleaner and cotton ball. Wipe out any debris and let the ear dry.
4. Apply the medication – Take off the cap. Gently insert just the tip into the ear opening (not deep), and slowly press the plunger to deliver the full dose.
5. Massage the ear – Rub the base of the ear for 30 seconds. The liquid will turn into a gel as it warms, and massaging helps it spread inside the ear.
6. Let them shake it out – It’s normal! Wipe away any extra gel you see near the ear opening.
7. Reward your pet – Offer praise or a treat to keep the experience positive.
8. Store and clean up – Recap the syringe and refrigerate if needed. Wash your hands afterward.

This compounded formulation combines active ingredients from different drug classes: amikacin, an aminoglycoside antibiotic; neomycin, an aminoglycoside antibiotic; and polymyxin B, a polymyxin antibiotic. In compounding practice, clinicians may consider a multi-ingredient preparation like this to address more than one aspect of a patient's physiology at once. Your veterinarian determines whether it is appropriate based on your animal's diagnostic findings.

At a pharmacological level, this medication functions through multiple synergistic pathways. Amikacin and neomycin are aminoglycosides that bind irreversibly to the 30S ribosomal subunit of susceptible bacteria, which interferes with protein synthesis and leads to cell death. Polymyxin B is a polypeptide antibiotic that acts by binding to and disrupting the bacterial cytoplasmic membrane, increasing its permeability and causing cellular leakage. This combined activity may help address the growth and replication of both Gram-positive and Gram-negative bacteria. Your veterinarian will determine the clinical appropriateness of this combination based on your pet’s diagnostic findings and the nature of any other prescriptions or treatments being administered.

This description reflects the general pharmacology of the active ingredient's drug class; your veterinarian determines whether this approach is appropriate for your animal.

Prescription only. Use only under the direction of a licensed veterinarian. This information is not a substitute for veterinary diagnosis, prescribing or monitoring. Compounded drugs are not approved by the FDA for safety or effectiveness.

Commonly observed effects of amikacin/neomycin/polymyxin B administration are primarily localized, though owners should watch for increased redness, swelling or sensitivity at the application site. Because aminoglycosides like amikacin and neomycin have been associated with ototoxicity (damage to hearing or balance) if they enter the middle ear, your veterinarian will evaluate the integrity of the eardrum before prescribing this for an ear infection. Additionally, some patients may exhibit localized hypersensitivity or allergic reactions to neomycin. Owners should monitor for any loss of balance, head tilting or unusual behavioral shifts and contact their veterinarian promptly if these occur.

This medication is typically used with extra caution or avoided in patients with a ruptured tympanic membrane (eardrum) or known hypersensitivity to any of the components. It is also carefully evaluated in pregnant or lactating animals, as systemic absorption of these active ingredients can occur, albeit in small amounts. Before starting a protocol, ensure your veterinarian has a complete history of all other medications your pet is receiving, as concurrent use of other aminoglycosides may increase the risk of adverse effects. Your veterinarian is the right person to provide guidance on the necessary duration of use and the proper application technique to ensure the management approach remains suitable for your pet's individual health status.