[Bacitracin photo]
KEY POINTS
- Bacitracin is an antibiotic that works by interfering with bacterial cell wall synthesis in susceptible organisms
- Bacitracin resistance in community-acquired MRSA can be a problem
- Can be given ophthalmic, intramuscular (IM) or topical
- DO NOT ADMINISTER INTRAVENOUSLY
- IM formulation is sometimes added to sterile irrigation solution and used topically during surgery for “washout”
- Reconstituted solution is very foamy and must sit for a long time to complete transition from powder to solution that can be aspirated from the vial
- Topical bacitracin is sometimes combined with neomycin and polymyxin B sulfates, which is the well-known brand name Neosporin
- Indications:
- Bacitracin injection has an indication for treatment of pneumonia and empyema in infants
- 1 unit is equivalent to 0.026 mg
- Bacitracin topical is indicated for topical infection prevention
- Topical bacitracin is typically applied 1 to 3 times per day
- Unusual to use for more than 7 days without prescriber oversight
- Bacitracin ophthalmic has an indication for superficial ocular infections
- Should not be used in deep seated ocular infections or for infections that are likely to become systemic infections
- Bacitracin injection has an indication for treatment of pneumonia and empyema in infants
- Toxicities:
- IM formulation has a FDA Boxed Warning due to risk of nephrotoxicity (tubular and glomerular necrosis)
- Adverse effects of the IM formulation may also include skin rash, albuminuria, nausea, vomiting, pain at injection site and anaphylaxis
- Beware anaphylaxis from topical bacitracin
- Beware hypersensitivity from ophthalmic bacitracin
RESOURCES