Generic Name: Bacitracin
VA Class: AM900
Molecular Formula: C66H103N17O16S
CAS Number: 1405-87-4
Restrict use to infants with pneumonia and empyema caused by susceptible staphylococci.104 137 Use only if adequate laboratory facilities are available and constant supervision of the patient is possible.104 137
Determine renal function prior to and daily during therapy.104 137 Do not exceed recommended daily dosage.104 137 Maintain fluid intake and urinary output at proper levels to avoid kidney toxicity.104 137
Discontinue drug if renal toxicity occurs.104 137 Avoid concurrent use of other nephrotoxic drugs, particularly aminoglycosides (streptomycin, kanamycin, neomycin, viomycin [not commercially available in the US]), polymyxin B, and colistimethate/colistin.104 137
Uses for BACiiM
Staphylococcal Pneumonia and Empyema in Infants
Not considered a drug of choice or alternative for staphylococcal infections.139 144 Penicillinase-resistant penicillins (nafcillin, oxacillin) are the usual drugs of choice for infections caused by penicillinase-producing staphylococci, and vancomycin (with or without gentamicin and rifampin) or linezolid usually is recommended for infections caused by methicillin-resistant staphylococci.105 138 139
Clostridium difficile-associated Diarrhea and Colitis
Has been used orally for the treatment of Clostridium difficile-associated diarrhea and colitis† (CDAD; antibiotic-associated diarrhea and colitis) or pseudomembranous colitis.100 101 102 103 105 117 140 143 Designated an orphan drug by FDA for use in this condition.114
Oral metronidazole or, alternatively, oral vancomycin usually is recommended for the treatment of CDAD.105 108 109 110 111 112 113 116 117 119 120 121 122 123 124 139 140 143 Some clinicians have suggested that oral bacitracin may be an alternative to metronidazole or vancomycin101 102 105 and may also be useful in patients who are allergic to vancomycin100 or whose diarrhea and/or colitis does not respond to vancomycin.100 101 102 However, oral preparations of bacitracin are not commercially available in the US.
BACiiM Dosage and Administration
Dissolve powder for injection in 0.9% sodium chloride injection containing 2% procaine hydrochloride. 104 137 Add 9.8 mL of this diluent to a vial containing 50,000 units to provide a solution containing 5000 units/mL.104 137 Bacitracin solutions containing <5,000 units/mL or >10,000 units/mL should not be used.104 137
Staphylococcal Pneumonia and Empyema in Infants
Clostridium-difficile-associated Diarrhea and Colitis
Staphylococcal Pneumonia and Empyema in Infants
No special population dosage recommendations at this time.a
Cautions for BACiiM
IM bacitracin may cause renal failure due to tubular and glomerular necrosis.104 137 Albuminuria,104 137 hematuria,a cylindruria,104 137 and rising blood concentrations of the drug104 137 may occur initially followed eventually by oliguria,a azotemia,104 137 and renal failure.104 137
Keep patient well hydrated using oral or, if necessary, parenteral fluids.104 137 Maintain urine output at proper levels to avoid renal toxicity.104 137 Some suggest using sodium bicarbonate or another alkali to keep urine at pH 6 or greater to avoid renal irritation.a
Respiratory paralysis may occur as a result of neuromuscular blockade, especially in patients with a neuromuscular disease such as myasthenia gravis.a Severe neuromuscular blockade resulting in respiratory depression unresponsive to calcium or neostigmine has occurred in several patients treated with bacitracin and neomycin sulfate instilled intrapleurally or into a pancreatic pseudocyst.a
Selection and Use of Anti-infectives
To reduce development of drug-resistant bacteria and maintain effectiveness of bacitracin and other antibacterials, use only for treatment or prevention of infections proven or strongly suspected to be caused by susceptible bacteria.104 137
When selecting or modifying anti-infective therapy, use results of culture and in vitro susceptibility testing.104 137 In the absence of such data, consider local epidemiology and susceptibility patterns when selecting anti-infectives for empiric therapy.104 137
Common Adverse Effects
Nephrotoxicity (albuminuria, cylindruria, azotemia, rising blood concentrations of the drug);104 137 GI effects (nausea, vomiting);104 137 pain at injection site;104 137 hypersensitivity reactions (rash).104 137
Interactions for BACiiM
Aminoglycosides (streptomycin, neomycin, kanamycin)
Polymyxin b sulfate
Neuromuscular blocking agents and general anesthetics
Possible prolongation of skeletal muscle relaxation and potentiation of neuromuscular blockadea
Not absorbed from GI tract, pleura, or synovia.a
Following a single IM dose of 10,000–20,000 units in adults with normal renal function, peak serum concentrations occur after 1–2 hours and are detectable in serum for 6–8 hours after the dose.a
Only trace amounts cross the blood-brain barrier into the CSF, unless the meninges are inflamed.a
IM: 10–40% of the dose is excreted slowly by glomerular filtration and appears in urine within 24 hours.a
Oral: Excreted in the feces.a
Powder for Injection
Following reconstitution, stable at 2–8°C for up to one week.104
Actions and Spectrum
May be bactericidal or bacteriostatic, depending on drug concentration at site of infection.a
Inhibits bacterial cell wall synthesis.a
Active in vitro against some gram-positive bacteria, including some staphylococci and streptococci.144 Also active in vitro against some gram-negative bacteria, including Neisseria, but not against most gram-negative bacilli.a
Advice to Patients
Advise patients that it is common to begin feeling better after a few days, but that skipping doses or not completing the full course of therapy may decrease effectiveness and increase the likelihood that bacteria will develop resistance and will not be treatable with bacitracin or other antibacterials in the future.104 137
Importance of informing clinicians of existing concomitant therapy, including prescription and OTC drugs, as well as any concomitant illnesses.a
Importance of informing patients of other important precautionary information.a (See Cautions.)
Excipients in commercially available drug preparations may have clinically important effects in some individuals; consult specific product labeling for details.
For injection, for IM use
Bacitracin for Injection
AHFS DI Essentials. © Copyright, 2004-2014, Selected Revisions September 1, 2009. American Society of Health-System Pharmacists, Inc., 7272 Wisconsin Avenue, Bethesda, Maryland 20814.
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a. AHFS drug information 2007. McEvoy GK, ed. Bacitracin. Bethesda, MD: American Society of Health-System Pharmacists; 2007:[page 453-454].