Yes

Antibiotic, Ophthalmic; Antibiotic, Topical; Antibiotic, Miscellaneous

Treatment of susceptible bacterial infections mainly has activity against gram-positive bacilli; due to toxicity risks, systemic and irrigant uses of bacitracin should be limited to situations where less toxic alternatives would not be effective; oral administration has been successful in antibiotic-associated colitis and has been used for enteric eradication of vancomycin-resistant enterococci (VRE)

C

Hypersensitivity to bacitracin or any component; I.M. use is contraindicated in patients with renal impairment

Prolonged use may result in overgrowth of nonsusceptible organisms; I.M. use may cause renal failure due to tubular and glomerular necrosis; do not administer intravenously because severe thrombophlebitis occurs

1% to 10%:

Central nervous system: Pain

Dermatologic: Rash, itching

Gastrointestinal: Anorexia, nausea, vomiting, diarrhea, rectal itching

Hematologic: Blood dyscrasias

Miscellaneous: Diaphoresis

Symptoms of overdose include nephrotoxicity (parenteral), nausea, vomiting (oral)

Increased toxicity: Nephrotoxic drugs, neuromuscular blocking agents, and anesthetics ( neuromuscular blockade)

For I.M. use; bacitracin sterile powder should be dissolved in 0.9% sodium chloride injection containing 2% procaine hydrochloride; once reconstituted, bacitracin is stable for 1 week under refrigeration (2°C to 8°C); sterile powder should be stored in the refrigerator; do not use diluents containing parabens

Inhibits bacterial cell wall synthesis by preventing transfer of mucopeptides into the growing cell wall

Duration of action: 6-8 hours

Absorption: Poor from mucous membranes and intact or denuded skin; rapidly absorbed following I.M. administration; not absorbed by bladder irrigation, but absorption can occur from peritoneal or mediastinal lavage

Distribution: Relative diffusion of antimicrobial agents from blood into cerebrospinal fluid (CSF): Nil even with inflammation

Protein binding: Minimally bound to plasma proteins

Time to peak serum concentration: I.M.: Within 1-2 hours

Elimination: Slow elimination into urine with 10% to 40% of dose excreted within 24 hours

Children and Adults ( do not administer I.V.):

less than or equal to 2.5 kg: 900 units/kg/day in 2-3 divided doses

>2.5 kg: 1000 units/kg/day in 2-3 divided doses

Children: I.M.: 800-1200 units/kg/day divided every 8 hours

Adults: Antibiotic-associated colitis: Oral: 25,000 units 4 times/day for 7-10 days

Topical: Apply 1-5 times/day

Ophthalmic, ointment: Instill 1/4 " to 1/2 " ribbon every 3-4 hours into conjunctival sac for acute infections, or 2-3 times/day for mild to moderate infections for 7-10 days

Irrigation, solution: 50-100 units/mL in normal saline, lactated Ringer's, or sterile water for irrigation; soak sponges in solution for topical compresses 1-5 times/day or as needed during surgical procedures

I.M.: Urinalysis, renal function tests

None reported

None reported

No information available to require special precautions

No effects or complications reported

Oral, I.M.: Maintain adequate hydration (2-3 L/day of fluids unless instructed to restrict fluid intake). Report rash, redness, or itching; change in urinary pattern; acute dizziness; swelling of face or lips; chest pain or tightness; acute nausea or vomiting; or loss of appetite (small frequent meals or frequent mouth care may help).

Ophthalmic: Instill as many times per day as directed. Wash hands before using. Gently pull lower eyelid forward, instill prescribed amount of ointment into lower eyelid. Close eye and roll eyeball in all directions. May cause blurred vision; use caution when driving or engaging in tasks that require clear vision. Report any adverse reactions such as rash or itching, swelling of face or lips, burning or pain in eye, worsening of condition, or if condition does not improve.

Topical: Apply a thin film as many times as day as prescribed to the affected area. May cover with porous sterile bandage (avoid occlusive dressings). Do not use longer than 1 week unless advised by healthcare provider.

Pregnancy/breast-feeding precautions: Inform prescriber if you are or intend to be pregnant. Consult prescriber if breast-feeding.

For I.M. administration, pH of urine should be kept above 6 by using sodium bicarbonate

Injection: 50,000 units

Ointment:

Ophthalmic: 500 units/g (1 g, 3.5 g, 3.75 g)

Topical: 500 units/g (1.5 g, 3.75 g, 15 g, 30 g, 120 g, 454 g)

Katz BE and Fisher AA, "Bacitracin: A Unique Topical Antibiotic Sensitizer," J Am Acad Dermatol, 1987, 17(6):1016-24.

Kelly CP, Pothoulakis C, and LaMont JT, " Clostridium difficile Colitis," N Engl J Med, 1994, 330(4):257-62.

Vale MA, Connolly A, Epstein AM, et al, "Bacitracin-Induced Anaphylaxis," Arch Dermatol, 1978, 114(5):800.

Westerman EL, "Toxicity of Mediastinal Irrigation With Bacitracin," JAMA, 1983, 250(7):899.