Bacitracins are branched, cyclic, decapeptide antimicrobials. Bacitracin is produced by Bacillus licheniformis and Bacillus subtilis. Bacitracin A is the most active of the group and the main component of the commercial bacitracin preparations used either topically or PO. These antimicrobials are bactericidal. They interfere with cell membrane function, suppress cell wall formation via preventing the formation of peptidoglycan strands, and inhibit protein synthesis. Bactericidal activity requires the presence of divalent cations, such as zinc. Bacitracin is metabolized to the inactive desamido bacitracin and excreted via the urine and feces.
The spectrum of bacitracins is broad, but it is used primarily to treat gram-positive infections. Resistance is rare. Bacitracins are often used in combination with neomycin and polymyxins to enhance the antibacterial spectrum.
Bacitracins are not appreciably absorbed from the GI tract and are not used systemically because of their pronounced nephrotoxicity. However, they are used locally in wound powders and ointments, dermatologic preparations, eye and ear ointments, and as feed additives in swine and poultry rations for growth promotion. In antimicrobial-associated pseudomembranous colitis due to Clostridium difficile cytotoxin, bacitracin (administered PO) is considered an alternative to vancomycin. Hypersensitivity reactions to bacitracins are seen occasionally.
