Dosage Forms
Excipient information presented when available (limited, particularly for generics); consult specific product labeling.
Ointment, Ophthalmic:
Generic: 500 units/g (3.5 g)
Pharmacology
Mechanism of Action
A cyclic peptide antibiotic that inhibits bacterial cell wall synthesis by preventing transfer of mucopeptides into the growing cell wall. Bacitracin is bacteriostatic in nature, but may be bactericidal depending on the antibiotic concentration and the susceptibility of the organism. The antibacterial spectrum is primarily gram positive with activity against staphylococci (including some penicillin G resistant strains), streptococci, anaerobic cocci, Clostridia, Corynebacterium, gonococci, meningococci, and fusobacteria. Other susceptible organisms include Treponema pallidum, Treponema vincentii, and Actinomyces israelii. Development of bacitracin resistance is rare; however, resistance to Staphylococcus aureus has been reported (Suzuki 2011).
Pharmacokinetics/Pharmacodynamics
Absorption
Topical: Negligible
Use: Labeled Indications
Ocular infections: Treatment of blepharitis and associated bacterial overgrowth; treatment of superficial ocular infections involving the conjunctiva or cornea due to susceptible organisms
Contraindications
Hypersensitivity to bacitracin or any component of the formulation
Dosage and Administration
Dosing: Adult
Ocular infections: Ophthalmic:
Blepharitis: Apply twice daily and at bedtime.
Superficial infections of the conjunctiva and/or cornea: Apply up to every 3 to 4 hours for 10 days as determined by severity of infection.
Dosing: Geriatric
Refer to adult dosing.
Dosing: Pediatric
Ophthalmic infection: Infants, Children, and Adolescents: Ophthalmic: Apply ribbon 1 to 3 times daily.
Administration
Ophthalmic: For topical ophthalmic use only; do not inject into the eye. Avoid contamination of ointment during application. Avoid excess ointment application. Patients should be instructed on proper administration of eye ointments. Do not touch the tip of the applicator to any part of the eye or surrounding adjacent areas.
Blepharitis: After carefully removing all scales and crusts, apply thin film uniformly over lid margins.
Superficial infections of the conjunctiva and/or cornea: Apply thin ¼ inch strip directly into conjunctival sac.
Storage
Store at 20°C to 25°C (68°F to 77°F).
Drug Interactions
There are no known significant interactions.
Adverse Reactions
1% to 10%: Hypersensitivity: Hypersensitivity reaction (7% [Hätinen 1985])
<1%, postmarketing, and/or case reports: Contact dermatitis (Pichichero 2011)
Warnings/Precautions
Concerns related to adverse effects:
- Bacterial overgrowth: Prolonged use or use in absence of infectious presence may result in overgrowth of nonsusceptible organisms, particularly fungi; if new infection develops, initiate appropriate therapy.
- Blurred vision: May cause blurred vision, which may impair physical or mental abilities; patients must be cautioned about performing tasks that require clear vision (eg, operating machinery or driving).
- Hypersensitivity/anaphylaxis: Use with caution in patients who have been previously exposed to bacitracin; contact dermatitis (Pichichero 2011) has been reported and may take several days of use to develop. Discontinue use if signs of an allergic sensitization reaction are noted, including itching, swelling, and conjunctival erythema.
Special populations:
- Contact lens wearers: Contact lenses should not be worn during treatment.
Other warnings/precautions:
- Appropriate use: Should not be used in deep seated ocular infections or if infection is likely to become systemic. Patients who do not respond to topical ophthalmic bacitracin treatment following 10 days of use should be reevaluated to ascertain appropriateness of continued antibiotic use.
Pregnancy
Pregnancy Considerations
Bacitracin is not absorbed systemically following ophthalmic administration (Robert 2001). If ophthalmic agents are needed during pregnancy, the minimum effective dose should be used in combination with punctal occlusion to decrease potential exposure to the fetus (Samples 1988).
Patient Education
- Discuss specific use of drug and side effects with patient as it relates to treatment. (HCAHPS: During this hospital stay, were you given any medicine that you had not taken before? Before giving you any new medicine, how often did hospital staff tell you what the medicine was for? How often did hospital staff describe possible side effects in a way you could understand?)
- Educate patient about signs of a significant reaction (eg, wheezing; chest tightness; fever; itching; bad cough; blue skin color; seizures; or swelling of face, lips, tongue, or throat). Note: This is not a comprehensive list of all side effects. Patient should consult prescriber for additional questions.
Intended Use and Disclaimer: Should not be printed and given to patients. This information is intended to serve as a concise initial reference for health care professionals to use when discussing medications with a patient. You must ultimately rely on your own discretion, experience, and judgment in diagnosing, treating, and advising patients.
