IDStewardship

Bacitracin

[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
  • 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

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