Brand name: Bacitraycin
Drug class: Antibacterials

Medically reviewed by Drugs.com on Oct 10, 2024. Written by ASHP.

Introduction

Polypeptide antibiotic.^{7 14 141 144}

Uses for Bacitracin, Bacitracin Zinc (Topical)

Superficial Bacterial Skin Infections

Used topically alone or in fixed combination with other anti-infectives (i.e., polymyxin B with or without neomycin) for prevention of superficial bacterial skin infections associated with minor cuts, scrapes, or burns.^{100 101 102 103 104 105 106 107 108 109 111 112 116 141 144}

Has been used alone or in fixed combination with other anti-infectives for topical treatment of minor skin infections caused by susceptible bacteria.^{14 116 141 144} Role, if any, of topical anti-infectives for treatment of superficial skin infections not fully elucidated.^a

Self-medication with topical anti-infectives for prevention or treatment^{† [off-label]} of superficial skin infections not usually recommended.^{116 a}

Infected Corticosteroid-responsive Dermatoses

Used topically in fixed combination with other anti-infectives (i.e., polymyxin B and neomycin) and a corticosteroid (i.e., hydrocortisone) for treatment of corticosteroid-responsive dermatoses with secondary infection.¹¹⁰

No evidence that fixed-combination topical preparations that include anti-infectives and a corticosteroid provide greater benefit than use of a topical corticosteroid alone after 7 days of treatment.¹¹⁰ Weigh possible benefits of fixed-combination topical preparation containing anti-infectives and a corticosteroid against risk that the corticosteroid may mask clinical signs of bacterial, fungal, or viral infections; prevent recognition of ineffectiveness of the anti-infective; or suppress hypersensitivity reactions to ingredients in the formulation.

Bacitracin, Bacitracin Zinc (Topical) Dosage and Administration

Administration

Topical Administration

Apply topically to skin as an ointment, cream, or powder.^{100 101 102 103 104 105 106 107 108 109 110 111 112}

For external use only on skin;^{100 101 102 103 104 105 106 107 108 109 110 111 112} do not use in the eyes.^{100 101 102 103 104 105 106 107 108 109 110 111 112}

Do not apply to extensive areas of skin, deep or puncture wounds, animal bites, or serious burns.^{100 101 102 103 104 105 106 107 108 109 111 112}

Apply small amount of topical ointment or cream (amount equal to surface area of fingertip) to cleansed, affected areas of skin.^{100 101 102 103 104 105 107 108 109 110 111 112} If using the powder, apply light dusting of powder to affected areas of skin.¹⁰⁶

May cover treated areas of skin with a sterile bandage.^{100 101 102 104 105 107 108 109 111 112}

Dosage

Pediatric Patients

Prevention of Superficial Bacterial Skin Infections

Topical

Children ≥2 years of age: Apply ointment to affected areas of skin 1–3 times daily.^{103 108 111}

May use for up to 1 week for self-medication.^{103 108 111} Discontinue use and contact a clinician if condition persists for >1 week or worsens.^{103 108 111}

Adults

Prevention of Superficial Bacterial Skin Infections

Topical

Ointment or cream: Apply to affected areas of skin 1–3 times daily.^{100 101 102 103 104 105 107 108 109 111 112}

Powder: Apply a light dusting on affected areas of skin 1–3 times daily.¹⁰⁶

May use for up to 1 week for self-medication.^{100 101 102 103 104 105 106 107 108 109 111 112} Discontinue use and contact a clinician if condition persists for >1 week or worsens.^{100 101 102 103 104 105 106 107 108 109 111 112}

Infected Corticosteroid-responsive Dermatoses

Topical

Ointment (fixed combination of bacitracin, polymyxin B, neomycin, and hydrocortisone): Apply thin film to affected areas of skin 2–4 times daily for up to 7 days.¹¹⁰

Prescribing Limits

Pediatric Patients

Prevention of Superficial Bacterial Skin Infections

Topical

Maximum duration: 1 week, unless directed by a clinician.^{100 101 102 103 104 105 106 107 108 109 111 112}

Adults

Prevention of Superficial Bacterial Skin Infections

Topical

Maximum duration: 1 week, unless directed by a clinician.^{100 101 102 103 104 105 106 107 108 109 111 112}

Infected Corticosteroid-responsive Dermatoses

Topical

Maximum duration: 7 days.¹¹⁰

Cautions for Bacitracin, Bacitracin Zinc (Topical)

Contraindications

• Sensitivity to bacitracin or any ingredient in the formulation.^{100 101 102 103 104 105 106 107 108 109 110 111 112}

• Fixed combination of bacitracin, polymyxin B, neomycin, and hydrocortisone: Hypersensitivity to any ingredient in the formulation or presence of tuberculous, fungal, or viral (e.g., herpes simplex, varicella zoster) skin lesions.¹¹⁰ Also contraindicated for use in eyes or in external ear canal if eardrum is perforated.¹¹⁰

Warnings/Precautions

Sensitivity Reactions

Minor skin irritation, rash, and allergic contact dermatitis or other hypersensitivity reactions have occurred.^{141 144}

More serious hypersensitivity reactions, including anaphylaxis, reported rarely following topical application to skin.^{113 114 115 141 144}

Topical anti-infectives, including bacitracin and neomycin, are known contact sensitizers.^a

Consider that patients allergic to bacitracin may have delayed cell-mediated contact dermatitis reactions or immediate IgE-mediated (e.g., anaphylactic) reactions to the drug.^{113 114 141 144}

If itching, burning, rash, or any other signs of sensitivity or allergic reaction occur, discontinue use and consult a clinician.^{100 101 102 103 104 105 107 108 109 110 111 112}

Patients allergic to one fixed-combination topical preparation should avoid preparations containing any of the component drugs.^a Patients sensitive to bacitracin may also have cross-sensitivity to polymyxin B.^{141 144} In addition, patients allergic to fixed combinations containing neomycin may also be allergic to other aminoglycosides.¹¹⁰

Other Warnings and Precautions

Do not use for >1 week unless directed by a clinician.^{100 101 102 103 104 105 107 108 109 110 111 112}

Prolonged use of topical anti-infectives may promote bacterial resistance and should be avoided.¹⁴¹ Overgrowth of nonsusceptible organisms, including fungi, may occur.¹¹⁰

Use of Fixed Combinations

When used in fixed combination with other topical anti-infectives (i.e., polymyxin B with or without neomycin), topical corticosteroids (i.e., hydrocortisone), or topical anesthetics (i.e., lidocaine, pramoxine), consider cautions, precautions, and contraindications associated with each drug in the fixed combination.^a

When fixed combinations containing neomycin used, consider that topical neomycin may cause cutaneous sensitization.^{110 141} A precise incidence of hypersensitivity reactions (primarily rash) due to topical neomycin not known.¹¹⁰

When fixed combination containing hydrocortisone used, consider that topical corticosteroids used in fixed combination with topical anti-infectives may mask clinical signs of bacterial, fungal, or viral infections, or may suppress hypersensitivity reactions to the anti-infectives or other ingredients in the formulation.¹⁴⁴ Also consider that use of topical corticosteroids can result in signs and symptoms of exogenous hyperadrenocorticism, including adrenal suppression, and that systemic absorption of topically applied corticosteroids is increased if extensive body surface areas treated or if occlusive dressing used.¹¹⁰ Do not use fixed combination preparation containing hydrocortisone for >7 days; discontinue use and contact clinician if redness, irritation, swelling, or pain persists or increases.¹¹⁰

Specific Populations

Pregnancy

Category C.¹⁴⁰

Some manufacturers advise pregnant patients to consult a clinician before using topical preparations containing bacitracin.^{101 103}

Fixed combination of bacitracin, polymyxin B, neomycin, and hydrocortisone: Use during pregnancy only if potential benefits justify potential risks to fetus.¹¹⁰ Topical corticosteroids are teratogenic in mice and rabbits.¹¹⁰

Lactation

Not known whether topical bacitracin is distributed into milk.¹⁴⁰

Some experts consider topical bacitracin compatible with nursing.¹⁴⁰

Some manufacturers advise breast-feeding women to consult a clinician before using topical preparations containing bacitracin.^{101 103}

Fixed combination of bacitracin, polymyxin B, neomycin, and hydrocortisone: Use with caution in nursing women.¹¹⁰ Hydrocortisone is distributed into human milk following oral administration;¹¹⁰ systemic absorption may occur when hydrocortisone is applied topically.¹¹⁰

Pediatric Use

Some manufacturers state do not use topical preparations containing bacitracin in children <2 years of age unless directed by a clinician.^{103 108 111}

Fixed combination of bacitracin, polymyxin B, neomycin, and hydrocortisone: Safety and efficacy not established in pediatric patients.¹¹⁰

Fixed combination of neomycin, polymyxin B, bacitracin, and lidocaine: At least one manufacturer states do not use in children <12 years of age unless directed by a clinician.¹¹²

Geriatric Use

Fixed combination of bacitracin, polymyxin B, neomycin, and hydrocortisone: Clinical studies did not include sufficient numbers of patients ≥65 years of age to determine whether geriatric individuals respond differently than younger patients;¹¹⁰ other reported clinical experience has not identified differences in responses between geriatric and younger patients.¹¹⁰

Common Adverse Effects

Minor skin irritation, rash, allergic contact dermatitis.^{141 144}

Bacitracin, Bacitracin Zinc (Topical) Pharmacokinetics

Absorption

Bioavailability

Not appreciably absorbed from intact or denuded skin, wounds, or mucous membranes.^{14 144}

Stability

Storage

Topical

Cream

Fixed combination of bacitracin zinc, neomycin, polymyxin B, and local anesthetic (i.e., lidocaine): 15–30°C;¹¹¹ protect from excessive heat and freezing.¹¹¹

Ointment

Bacitracin: 20–25°C.^{100 101}

Bacitracin zinc: 15–30°C;¹⁰² avoid exposure to excessive heat and humidity.¹⁰²

Fixed combinations of bacitracin zinc and polymyxin B with or without neomycin: 20–25^{105 107} or 15–30°C,¹⁰⁹ depending on manufacturer.

Fixed combination of bacitracin zinc, polymyxin B, neomycin, and hydrocortisone: 15–25°C.¹¹⁰

Fixed combinations of bacitracin zinc and local anesthetic (i.e., lidocaine, pramoxine) with or without neomycin and polymyxin B: 15–30°C, depending on manufacturer;^{103 108 111 112} protect from excessive heat^{111 112} and freezing.¹¹¹

Powder

Fixed combination of bacitracin zinc and polymyxin B: 20–25°C;¹⁰⁶ do not refrigerate.¹⁰⁶

Actions and Spectrum

• Polypeptide antibiotic produced by Bacillus subtilis or B. licheniformis.^{7 14 141 144} Mixture of polypeptides (bacitracin A, B1, B2, and B3);^{7 14} major component is bacitracin A.^{141 144}

• May be bactericidal or bacteriostatic depending on concentration of the drug at site of infection and susceptibility of infecting organism.^a

• Inhibits bacterial cell wall synthesis by preventing incorporation of amino acids and nucleotides into the cell wall.^a

• Active against some gram-positive aerobic bacteria (e.g., Staphylococcus aureus, Streptococcus pyogenes, Corynebacterium).^{14 141 144}

• Active against some gram-negative aerobic bacteria (e.g., Haemophilus influenzae, Neisseria), but not active against most gram-negative bacilli.¹⁴⁴

• Activity of bacitracin is not impaired by blood, pus, necrotic tissue, or large inocula.^a

• Staphylococci (e.g., S. aureus) and streptococci resistant to bacitracin reported.^{14 141 144}

• No cross-resistance between bacitracin and other anti-infectives.^a

Advice to Patients

• Inform patients that topical preparations containing bacitracin are for external use only; do not use in the eyes and do not apply over large areas of the body.^{100 101 102 103 104 105 106 107 108 109 110 111 112}

• For self-medication, importance of not using topical preparations containing bacitracin for >1 week for prevention of infection in minor skin injuries (e.g., cuts, scrapes, burns);^{100 101 102 103 104 105 107 108 109 111 112} importance of discontinuing use and consulting a clinician if condition persists or worsens.^{100 101 102 103 104 105 107 108 109 111 112}

• Importance of discontinuing topical preparation containing bacitracin and consulting a clinician if itching, burning, rash, or any other signs of sensitivity or allergic reaction occur.^{100 101 102 103 104 105 107 108 109 111 112 a}

• Importance of first consulting a clinician if considering use for self-medication for deep or puncture wounds, animal bites, or serious burns.^{100 101 102 103 104 105 106 107 108 109 111 112}

• Importance of women informing clinicians if they are or plan to become pregnant or plan to breast-feed.^{101 103 a}

• Importance of informing patients of other important precautionary information.^a

Additional Information

The American Society of Health-System Pharmacists, Inc. represents that the information provided in the accompanying monograph was formulated with a reasonable standard of care, and in conformity with professional standards in the field. Readers are advised that decisions regarding use of drugs are complex medical decisions requiring the independent, informed decision of an appropriate health care professional, and that the information contained in the monograph is provided for informational purposes only. The manufacturer’s labeling should be consulted for more detailed information. The American Society of Health-System Pharmacists, Inc. does not endorse or recommend the use of any drug. The information contained in the monograph is not a substitute for medical care.

Preparations

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Please refer to the ASHP Drug Shortages Resource Center for information on shortages of one or more of these preparations.

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