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bacitracin

R02AB04

Forms & Strengths

Ointment, topical: 500 units/g
Ophthalmic ointment: 500 units/g
Injection: 50,000 units per vial (for intramuscular use only)

Adult Dosing

Topical: Apply small amount to affected area 1 to 5 times daily
Ophthalmic: Apply 0.5 inch ribbon to conjunctival sac every 3 to 4 hours for severe infections, or less frequently for mild infections
Intramuscular (systemic): 25,000 units every 8 hours (maximum 100,000 units/day for localized staphylococcal infections in infants)

Pediatric Dosing

Topical (infants > 2 months and children): Apply small amount 1 to 5 times daily
Ophthalmic: Apply thin ribbon into conjunctival sac 2 to 3 times daily or every 3 to 4 hours
Intramuscular (infants > 2.5 kg): 900 to 1,000 units/kg/day divided every 8 to 12 hours
Intramuscular (infants < 2.5 kg): 700 to 900 units/kg/day divided every 8 to 12 hours

Indications

Prevention of minor skin infections in minor cuts, scrapes, and burns
Treatment of superficial ocular infections involving the conjunctiva and/or cornea caused by susceptible organisms
Parenteral treatment of infants with pneumonia and empyema caused by susceptible staphylococci (restricted due to nephrotoxicity)

Mechanism of Action

Inhibits bacterial cell wall synthesis by interfering with the dephosphorylation of C55-isoprenyl pyrophosphate (bactoprenol pyrophosphate), preventing the transfer of peptidoglycan subunits to the growing cell wall

Contraindications

Hypersensitivity to bacitracin or any component of the formulation
Systemic administration in patients with preexisting renal impairment
Use in deep puncture wounds, severe burns, or large areas of raw skin when absorbed systemically

Adverse Reactions

Topical/Ophthalmic: Contact dermatitis, rash, itching, burning, angioedema, anaphylaxis
Systemic (Parenteral): Nephrotoxicity (albuminuria, cylindruria, azotemia), acute tubular necrosis, superinfection, pain at injection site, nausea, vomiting

Drug Interactions

Aminoglycosides (e.g., streptomycin, neomycin): Increased risk of nephrotoxicity and neuromuscular blockade
Neuromuscular blocking agents: Potentiation of paralysis when administered parenterally
Nephrotoxic drugs (e.g., polymyxin B, colistin, vancomycin): Additive nephrotoxic effects

Curated Content: Needs Vetting Before Put to Clinical Use