Bacitracin is an antibacterial drug that is primarily used in combination with other antiseptics and antibiotics for topical use. Very rarely, it is administered intramuscularly when other less toxic medications are not suitable.

• It is used to treat infants with bacitracin-susceptible staphylococci-induced pneumonia and empyema (where less toxic therapies are not suitable)

• In adults, it is used as an off-label medication to treat diarrhea caused by clostridium difficile and for the eradication of enteric vancomycin-resistant enterococci.

• It is also used as a topical medicine for the treatment of suerficial skin and eye infections.

Bacitracin Dose in Adults

• Diarrhea caused by clostridium defficile infection (Unlabeled use): 

  • 4 times a day for seven to ten days, 25,000 units.

• Vancomycin resistant enterococci eradication: 

  • 4 times a day for seven to ten days, 25,000 units.

• Superficial dermal infection: 

  • Apply 1-3 times a day.

• Ophthalmic infection as ophthalmic ointment:

  • In acute infections, Instill 1 / 4 ” to 1 / 2 ” ribbon every 3-4 hours into conjunctival sac or 2 - 3 times a day for mild to moderate infections for 7 - 10 days.

Bacitracin Dose in Children

Use in the treatment of staphylococcal Pneumonia and empyema:

Note: 

• It should only be used in situations where other less toxic drugs can not be used.

Intravenous administration should be avoided

• Infants:
  • less than 2.5 kgs:
    • 900 units/kg/day intramuscular in 2 - 3 divided doses
  • more than 2.5 kgs:
    • 1000 units/kg/day intramuscular in 2 - 3 divided doses

Use in pregnancy and breastfeeding

• It is not recommended to be used in women of child-bearing age.

Bacitracin Dose in Renal Disease:

• Not recommended in moderate to severe hepatic impairment.

Bacitracin Dose in Liver Disease:

• Adjustment in the dose has not been recommended by the manufacturer, however, it may be used with extreme caution.

Side Effects of Bacitracin Frequency not defined.

• Dermatologic:
  • Skin rash
• Endocrine & metabolic:
  • Albuminuria
• Gastrointestinal:
  • Nausea
  • Vomiting
• Genitourinary:
  • Azotemia
  • Casts in urine
  • Nephrotoxicity
• Local:
  • Pain at the injection site
• Renal:
  • Renal failure

Contraindication to Bacitracin include:

• Allergic reactions to bacitracin and any component of the formulation

Warnings and Precautions

• Anaphylaxis
  • Patients who have previously received bacitracin are more likely to experience severe anaphylactic reactions if exposed again.
• Failure of the renal system: [US Boxed Warning]
  • Patients may experience renal impairment due to glomerular or tubular necrosis.
  • Patients are advised to ensure adequate hydration and urine output during treatment.
  • Do not exceed the recommended dosage and avoid concomitant use of nephrotoxic medications.
• Super infection
  • Long-term use can lead to super infections, including bacterial and fungal super infections.
  • Clostridium difficile-associated diarrhea and pseudomembranous collitis are both possible. These can occur even after two months.

Bacitracin (systemic): Drug Interaction

Note: Drug Interaction Categories:

• Risk Factor C: Monitor When Using Combination
• Risk Factor D: Consider Treatment Modification
• Risk Factor X: Avoid Concomitant Use

Monitoring Parameters:

 Monitor urinalysis, urine output, and renal function tests.

How to administer Bacitracin?

• It should be only administered intramuscularly in the upper outer quadrant of the buttocks. The administration site should be rotated.
• It should not be administered intravenously.

Mechanism of action of Bacitracin:

• It is an antibacterial drug which prevents mucopeptides from being transferred into growing bacteria cells.
• As a result, the development of bacterial cell walls is inhibited.

It is growing rapidly absorbed. After an intramuscular injection, it is widely distributed It is found in all organs of the body, including the ascitic fluid and pleural fluid. It is excreted Primarily in the urine.

International Brands of Bacitracin:

• BACiiM
• Baciject

Bacitracin Brands in Pakistan: