BACITRACIN
| BACITRACIN (bass-i-tray'sin) Baciim Classifications: antibiotic; Therapeutic: antibiotic Pregnancy Category: C |
Availability
50,000 unit vial; 500 units/g ophthalmic ointment
Action
Polypeptide antibiotic derived from cultures of Bacillus subtilis. Interferes with the bacterial cell membrane by inhibiting cell wall synthesis.
Therapeutic Effect
Spectrum of antibacterial activity similar to that of penicillin. Active against many gram-positive organisms. Ineffective against most other gram-negative organisms.
Uses
Parenteral therapy restricted to infants with Staphylococcal pneumonia and empyema where adequate laboratory facilities and constant supervision are available. Used topically in treatment of superficial infections of skin.
Unlabeled Uses
Orally for treatment of antibiotic-associated colitis.
Contraindications
Toxic reaction or renal dysfunction associated with bacitracin; pulmonary disease; atopic individuals; pregnancy (category C).
Cautious Use
Myasthenia gravis or other neuromuscular disease; renal impairment, lactation. Patients allergic to neomycin may be sensitive to bacitracin.
Route & Dosage
| Systemic Infections Child: IM <2.5 kg, up to 900 U/kg/24 h divided q8–12h; >2.5 kg, up to 1000 U/kg/24h divided q8–12h Skin Infections Adult: Topical Apply thin layer of ointment b.i.d., t.i.d., as solution of 250–1000 U/mL in wet dressing |
Administration
Intramuscular- Do not use parenteral bacitracin for longer than 12 d.
- Reconstitute with NS containing 2% procaine hydrochloride (prescribed). Do not reconstitute with diluents containing parabens because solution may precipitate or become cloudy.
- Alternate injection sites since injections are painful.
- Dry bacitracin vials should be stored in refrigerator at 2°–8° C (36°–46° F). Store solution for a maximum of 1 wk if refrigerated. Inactivation occurs at room temperature.
- Clean affected area prior to application. May be covered with a sterile bandage.
- Store ointments in tightly closed containers at 15°–30° C (59°–86° F) unless otherwise directed.
Adverse Effects (≥1%)
GI: Anorexia, nausea, vomiting, diarrhea, rectal itching and burning. Hematologic: Systemic use: Bone marrow depression, blood dyscrasias; eosinophilia. Body as a Whole: Hypersensitivity (erythema, anaphylaxis). Urogenital: Nephrotoxicity; dose related: Increased BUN, uremia, renal tubular and glomerular necrosis. Special Senses: Tinnitus. Other: Pain and inflammation at injection site, fever, superinfection, neuromuscular blockade with respiratory depression.Interactions
Drug: With aminoglycosides, possibility of additive nephrotoxic and neuromuscular blocking effects; with tubocurarine and other nondepolarizing skeletal muscle relaxants, possibility of additive neuromuscular blocking effects.Pharmacokinetics
Absorption: Poorly absorbed from intact or denuded skin or mucous membranes. Peak: 1–2 h IM. Duration: 6–8 h. Distribution: Widely distributed including peritoneal and ascitic fluids. Elimination: Slow renal excretion (10–40% in 24 h).Nursing Implications
Assessment & Drug Effects
- Lab tests: Baseline C&S tests prior to initiation of therapy; start drug pending results.
- Determine BUN and nonprotein nitrogen (NPN); examine urine for albumin, casts, and cellular elements, before systemic therapy is started. Monitor renal function daily throughout therapy.
- Watch for signs of local allergic reaction (itching, burning, redness) with topical skin applications. Local reactions have preceded life-threatening anaphylactic episodes.
- Monitor I&O during parenteral therapy. Adequate urinary output is important to reduce possibility of renal toxicity. If fluid intake is inadequate or urinary output decreases, report to physician.
- Inspect urine for turbidity and hematuria, and watch for other S&S of urinary tract dysfunction. Report any changes in urination pattern (e.g., oliguria, urinary frequency, nocturia).
- Note: Prolonged use may result in overgrowth of nonsusceptible organisms, especially Candida albicans.
Patient & Family Education
- Report local allergic reactions with topical applications (e.g., itching, burning, redness).
Common adverse effects in italic, life-threatening effects underlined; generic names in bold; classifications in SMALL CAPS; 
Canadian drug name; 
Prototype drug