Bacitracin allergy

Introduction

Bacitracin was declared the Contact Allergens of the year 2003 by the American contact Dermatitis Society (ACDS). Allergic contact dermatitis caused by bacitracin is in the top ten Allergens in the United States that causes allergic contact dermatitis.¹

Bacitracin is the active ingredient in a wide variety of current antibacterial agents²

What is bacitracin and where is it found?

Bacitracin is a broad-spectrum polypeptide antibiotic. It is synthesized from organisms from the group of licheniformes Bacillus subtilis var Tracy, first isolated in the 1940s.³ It is bacteriostatic (or bactericidal in sufficient quantities) and acts on gram-negative and some gram-negative organisms. bacteria by disrupting the cell wall and peptidoglycan synthesis.

What is bacitracin used for?

Ophthalmic and ear medications.

Bacitracin is used in superficial eye infections involving conjunctiva (conjunctivitis) or cornea (keratitis) and for infections of the external auditory canal (otitis externa).^4,6

Topical use on the surface of the skin.

• To prevent infection on minor cuts, scrapes and burns.
• During and after surgery to prevent infection.

Bacitracin is used alone or in combination with other products, including:

• Neomycin
• Polymyxin B
• The store anestheticlignocaine
• Hydrocortisone (mild topical steroid)

Treatment of large areas of skin can be dangerous due to toxicity to the nervous system and kidneys, particularly in children, the elderly and those with renal disability.

Injection

• The only systemic the use of bacitracin is in neonatal pneumonia and empyema caused by susceptible staphylococci. Renal function should be monitored for nephrotoxicity.

Bacitracin is not used orally because it is toxic and it doesn't work well orally.

How does bacitracin work? allergy Present?

Bacitracin allergy presents as classic allergic contact dermatitis, either as a acute vesicular dermatitis or as chronic worsening dermatitis.^{5 5} It can also rarely present as systemic contact dermatitis.

When bacitracin ointment applied to broken skin, systemic absorption may cause anaphylactoid reactions Bacitracin has been identified as the most common topical antibiotic causing anaphylaxis.^{6 6} Serious reactions have occurred, some during surgery and others in healthy people after applying bacitracin ointment to abrasions. ^{7 7}Anaphylactoid reactions have ranged from cardiac arrest, loss of consciousness and apnea, to swelling of the lips and face, sweating and generalized Itch.

Am I allergic to topical bacitracin?

Allergic reactions It may be due to bacitracin or to irritation or allergy to other components of the preparation, such as the antibacterial agent neomycin, which is known to be a potent sensitizer.

Bacitracin allergy is confirmed by performing patch bacitracin tests. The correct concentration is uncertain, ranging between 1% and 20% of bacitracin in petroleum jelly (Vaseline).^8,9 About 50 percent of patients have a late reaction with the positive bacitracin patch test seen only at the 96-hour reading.¹⁰

Cross sensitivities

It is important to note that bacitracin and neomycin can co-react, even though they are not chemically related. Additionally, sensitivity to bacitracin may be experienced along with sensitivities against other antibiotics. This may be due to the use of multiple antibiotics at the same time.

Treatment of allergy to bacitracin.

Treatment depends on the severity of the reaction. Once the allergy has been confirmed, the first step is to avoid any contact with it.

Treatment of contact dermatitis is as for any acute dermatitis /eczema, i.e. topical corticosteroids, emollients, antibiotic treatment of any secondary bacterial infection (Staphylococcus aureus), etc.

Bacitracin can be retained in fabric and may be difficult to remove. New clothing may be required to resolve the dermatitis.^{6 6}

Severe anaphylaxis is a medical emergency. Those at risk for this type of reaction should wear or carry some type of medical alert (for example, “Medical Alert” bracelet) to warn healthcare personnel to avoid using products containing bacitracin.

What should I do to avoid a bacitracin allergy?

You ask dermatologist or pharmacist for a complete list of all substances to avoid and for safe alternatives. Your doctor may have more specific advice related to your particular situation.

Alert your pharmacist and doctors to your allergy so that suitable alternatives to bacitracin can be prescribed.

More information

Formula: C66H103N17O16S

CAS number: 1405-87-4

Cross reactions:

Cross reactions are reported to:

• Neomycin
• Gentamicin
• Kanamycin
• Streptomycin
• Spectinomycin
• Tobramycin
• Paromomycin
• Butyrosine
• Polymyxin, which is also obtained from Bacillus subtilis^{6 6}

Sensitizer: bacitracin

Patch Test: Bacitracin 5% in Vaseline