What is bacitracin

Bacitracin is a polypeptide broad-spectrum antibiotic. Bacitracin is synthesized from organisms of the licheniformis group of Bacillus subtilis var Tracy, first isolated in the 1943 ¹. Bacitracin unique name was derived from the fact that the Bacillus subtilis var Tracy producing it was first isolated in 1943 from a knee scrape from a girl named Margaret Tracy. As a toxic and difficult-to-use antibiotic, bacitracin doesn’t work well orally. However, bacitracin is very effective topically. Bacitracin is bacteriostatic (or bacteriocidal in sufficient quantities) and acts on Gram-positive and some Gram-negative bacteria by disrupting cell wall and peptidoglycan synthesis.

What is bacitracin used for?

Bacitracin is NOT used orally because it is toxic and does not work well orally.

Ophthalmic and ear medications

Bacitracin with a prescription is used in superficial eye infections involving the conjunctiva (conjunctivitis) or cornea (keratitis), and for infections of the external ear canal (otitis externa) ².

Topical use on the skin surface

• To prevent infection in minor cuts, scrapes and burns.
• During and after surgery to prevent infection.

If you are using bacitracin without a prescription (bacitracin over the counter), do NOT use it to treat deep wounds, puncture wounds, serious burns, or raw areas without first checking with your health care professional.

Do NOT use bacitracin in the eyes.

Before applying bacitracin, wash the affected area with soap and water, and dry thoroughly.

After applying bacitracin, the treated area may be covered with a gauze dressing if desired.

To help clear up your infection completely, keep using this medicine for the full time of treatment, even if your symptoms have disappeared. Do not miss any doses.

Bacitracin is used alone or in combination with other products, including:

• Neomycin
• Polymyxin B
• The local anaesthetic, lignocaine
• Hydrocortisone (mild topical steroid)

Treatment of large areas of skin can be dangerous due to toxicity to the nervous system and kidneys, particularly in children, in the elderly, and in those with renal impairment.

Bacitracin injection

The only systemic use of bacitracin is in neonatal pneumonia and empyema caused by susceptible staphylococci. Kidney function must be monitored for nephrotoxicity.

Bacitracin is injected into a muscle. A healthcare provider will give your baby this injection.

Lung infections in infants are serious conditions, and your baby will most likely be kept in the hospital while being treated with bacitracin injection.

• While receiving bacitracin injection, your baby’s kidney function will need to be tested daily.

Your baby should not receive bacitracin if he or she is allergic to bacitracin.

To make sure bacitracin is safe for your baby, tell the doctor if your baby has:

• kidney disease; or
• any known allergies.

What other drugs will affect bacitracin injection?

Bacitracin can harm your baby’s kidneys. This effect is increased when the baby also receives certain other medicines. Tell your doctor about all medicines your baby uses, especially:

• antivirals;
• chemotherapy;
• injected antibiotics;
• medicine for bowel disorders;
• medicine to prevent organ transplant rejection; or some pain or arthritis medicines (including aspirin, Tylenol, Advil, and Aleve).

This list is not complete. Other drugs may interact with bacitracin, including prescription and over-the-counter medicines, vitamins, and herbal products. Not all possible interactions are listed in this medication guide.

Bacitracin dosage

Bacitracin topical dosage

Clean the affected area prior to use. Apply a small amount of product (an amount equal to the surface area of the tip of a finger); may cover with sterile bandage.

For prevention of minor bacterial infections:

• Adults and children—Apply to the affected area(s) of the skin two to five times a day.
• If your skin problem does not improve within 1 week, or if it becomes worse, check with your health care professional.

Use longer than 1 week is not recommended unless directed by your doctor. Do not use in eyes or over large areas of the body. Seek advice from health care provider prior to use for deep puncture wounds, bites, or serious burns, or if condition lasts longer than 1 week.

Bacitracin for burns

One method of treating partial thickness burns is to cover them with topical antibiotic ointments, like bacitracin or triple-antibiotic (neomycin, polymyxin B, and bacitracin) ointment, and then apply a simple absorbent dressing. The ointment can be spread on the dressing like peanut butter on bread, then placed on the burn. Dressings are changed once or twice a day and may take 1-2 weeks to heal ³.

Bacitracin injection dosage

Bacitracin injection is used in infants to treat pneumonia. It is also used to treat an infection that causes pus to build up between the lungs and the membrane that covers them.

Bacitracin can harm your baby’s kidneys. This effect is increased when the baby also uses certain other medicines, especially injected antibiotics. Your baby’s kidney function will need to be tested before and during treatment with bacitracin.

Pediatric Dose for Pneumonia

Use: For the treatment of pneumonia and empyema due to staphylococci with confirmed susceptibility to this drug

Infants:

• Under 2.5 kg: 900 units/kg/24 hours IM (intramuscular) in 2 or 3 divided doses
• Over 2.5 kg: 1000 units/kg/24 hours IM (intramuscular) in 2 or 3 divided doses

Pediatric Dose for Bacterial Infection

Use: For the treatment of pneumonia and empyema due to staphylococci with confirmed susceptibility to this drug

Infants:

• Under 2.5 kg: 900 units/kg/24 hours IM (intramuscular) in 2 or 3 divided doses
• Over 2.5 kg: 1000 units/kg/24 hours IM (intramuscular) in 2 or 3 divided doses

Bacitracin side effects

Bacitracin topical side effects

See your doctor or get medical help right away if you have any of the following signs or symptoms that may be related to a very bad side effect:

• Signs of an allergic reaction, like rash; hives; itching; red, swollen, blistered, or peeling skin with or without fever; wheezing; tightness in the chest or throat; trouble breathing, swallowing, or talking; unusual hoarseness; or swelling of the mouth, face, lips, tongue, or throat.

These are not all of the side effects that may occur. If you have questions about side effects, see your doctor. Call your doctor for medical advice about side effects.

Bacitracin allergy

Bacitracin allergy presents as classic allergic contact dermatitis, either as an acute vesicular dermatitis or as a chronic dermatitis that is becoming worse ⁴. Bacitracin allergy can also rarely present as systemic contact dermatitis.

When bacitracin ointment is applied to broken skin, systemic absorption may result in anaphylactoid reactions. Bacitracin has been identified as the most common topical antibiotic to cause anaphylaxis ². Severe reactions have occurred — some during surgery and some in healthy people after applying bacitracin ointment to abrasions ⁵. Anaphylactoid reactions have ranged from cardiac arrest, unconsciousness and apnea, to swelling of the lips and face, sweating, and generalized itching.

Allergic reactions may be due to bacitracin or to irritation from or allergy to other components of the preparation, such as the antibacterial agent neomycin, which is known to be a potent sensitizer.

Bacitracin allergy is confirmed by performing patch tests to bacitracin. The correct concentration is uncertain, ranging from 1% to 20% bacitracin in petrolatum (petroleum jelly) ⁶. About 50 percent of patients have a delayed reaction with the positive bacitracin patch test seen only at the 96-hour reading ⁷.

Cross-sensitivities

It is important to note that bacitracin and neomycin may co-react, even though they are chemically unrelated. Additionally, bacitracin sensitivity may be experienced along with sensitivities against other antibiotics. This may be due to using multiple antibiotics at the same time.

What should I do to avoid bacitracin allergy?

Ask your dermatologist or pharmacist for a full list of all the substances that should be avoided and for safe alternatives. Your doctor may have further specific advice relating to your particular situation.

Alert your pharmacist and your doctors to your allergy, so that suitable alternatives to bacitracin can be prescribed.

Treatment of bacitracin allergy

Treatment depends on the severity of the reaction. Once bacitracin allergy has been confirmed, the first step is to avoid any contact with bacitracin.

Treatment of contact dermatitis is as for any acute dermatitis/eczema, i.e. topical corticosteroids, emollients, antibiotic treatment of any secondary bacterial infection (Staphylococcus aureus), etc.

Bacitracin may be retained in fabric and may be difficult to wash out. New clothing may be required to solve the dermatitis ².

Severe anaphylaxis is a medical emergency. Those at risk of this type of reaction should wear or carry some form of medical alert (e.g., “Medic Alert” bracelet) to warn health-care personnel to avoid using bacitracin-containing products.

Bacitracin injection side effects

Get emergency medical help if your baby has any of these signs of an allergic reaction: hives; difficult breathing; swelling of the face, lips, tongue, or throat.

Antibiotic medicines can cause diarrhea, which may be a sign of a new infection. If your baby has diarrhea that is watery or bloody, call your doctor. Do not give your baby anti-diarrhea medicine unless your doctor tells you to.

While receiving bacitracin injection, your baby will be watched for the following side effects:

• diarrhea that is watery or bloody;
• urinating more than usual or more often;
• little or no urinating (fewer wet diapers);
• blood in the urine;
• lower back pain; or
• painful urination.

Common side effects include:

• nausea, vomiting;
• mild skin rash; or
• pain, burning, or swelling where the medicine was injected.

This is not a complete list of side effects and others may occur.

References

1. Bacitracin. https://www.drugbank.ca/drugs/DB00626#identification
2. Allergic Contact Dermatitis and Topical Antibiotics. https://www.medscape.com/viewarticle/735534
3. Schaefer TJ, Tannan SC. Burns, Thermal. [Updated 2018 Oct 27]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2018 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK430773
4. Vazirnia A, Jacob SE. Review ACDS Allergen of the Year 2000-2015. The Dermatologist [Internet] Volume 22 – Issue 11 November 2014. https://www.the-dermatologist.com/content/review-acds%E2%80%99-allergen-od-year-2000-2015
5. Bacitracin after clean surgical procedures may be risky. Jacob, Sharon E. et al. Journal of the American Academy of Dermatology , Volume 51 , Issue 6 , 1036 https://www.jaad.org/article/S0190-9622(04)01332-5/pdf
6. Nelson JL, Mowad CM. Allergic Contact Dermatitis: Patch Testing Beyond the TRUE Test. J Clin Aesthet Dermatol. 2010;3(10):36-41. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2958195/
7. Allergic contact dermatitis to topical antibiotics: Epidemiology, responsible allergens, and management. J Am Acad Dermatol. 2008 Jan;58(1):1-21. https://www.jaad.org/article/S0190-9622(07)01330-8/fulltext