Bacitracin Zinc (Topical Antibiotic)

How it works

Bacitracin inhibits bacterial cell-wall synthesis by interfering with dephosphorylation of the lipid carrier that transports peptidoglycan precursors across the membrane.

Prescribing in practice

• Topical bacitracin is a recognised cause of allergic contact dermatitis and can rarely trigger anaphylaxis, so avoid in patients with known hypersensitivity and on extensive or chronic wounds.
• Use is restricted to topical application because systemic absorption can be nephrotoxic.
• Reserve for localised superficial infection and avoid prolonged use to limit sensitisation and resistance.

Monitoring

Monitor the treated area clinically for response and for signs of contact allergy or worsening infection.

Counselling the patient

• Apply a thin layer to the affected area as directed.
• Stop and seek advice if a rash, itching or swelling develops at the site.
• Do not use on large open wounds unless specifically advised.

Evidence & guidelines

Topical bacitracin is a long-established antibacterial, though guidance discourages routine use on chronic wounds owing to contact-sensitisation risk.