Evidence Grade A — Regulatory approved. 4076 published studies. 39 registered clinical trials.
Medically reviewed by a licensed medical professional
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Bacitracin is one of the most familiar topical antibiotics in the world — it is a key ingredient in household first-aid products like Neosporin and Polysporin. Applied to minor cuts, scrapes, and burns, it kills bacteria on the skin's surface to help prevent infection. An injectable form exists but is almost never used because of severe kidney toxicity.
Bacitracin is also known by these brand and alternate names:
4,076 published studies: 1398 human, 1227 animal, 438 in-vitro, 134 reviews
Bacitracin is marketed as Baciguent (topical) and BACiiM (injection), and is a component of Neosporin and Polysporin. Approved in 1948, it is one of the oldest peptide antibiotics still in widespread use.
Topical bacitracin is available over the counter and is applied to minor cuts, scrapes, and burns to prevent infection. Its systemic use is limited to rare situations where no alternatives exist, due to severe nephrotoxicity. There has been growing discussion in wound care about whether routine topical antibiotic use on minor wounds provides meaningful benefit over simple petroleum jelly in keeping wounds moist, and about the risk of contact allergic dermatitis with repeated bacitracin use.
Bacitracin disrupts bacterial cell wall construction at a different point than vancomycin. It binds to a lipid carrier molecule (undecaprenyl pyrophosphate) that acts as a shuttle, carrying cell wall building blocks across the bacterial membrane. By trapping this shuttle in its used form, bacitracin prevents it from being recycled for another round of delivery. Without this carrier, the bacterium cannot transport new cell wall components to where they are needed, and wall construction stops. This mechanism requires zinc as a cofactor.
Bacitracin has been in use since 1948, long before modern clinical trial standards were established, so its evidence base is largely historical rather than built on large randomised trials. Its effectiveness as a topical antibiotic for minor wounds is generally accepted, though there is growing debate in wound care about whether topical antibiotics provide meaningful benefit over simply keeping wounds moist with plain petroleum jelly. A notable concern is allergic contact dermatitis — skin allergy testing data suggests bacitracin is one of the more common contact allergens, particularly in people with chronic wounds. The injectable form carries a boxed warning for kidney toxicity. Research into next-generation bacitracin variants with activity against resistant bacteria (including vancomycin-resistant organisms) has shown early promise in laboratory studies.
PeptideTrace tracks 39 registered clinical trials for Bacitracin sourced from ClinicalTrials.gov.
Nailbed Repair for Patients With Nailbed Injuries
Multi-omics Dissection of Gut Microbiome Engraftment During FMT
Clinical Assessment of Protopic® Ointment in Deep Partial-Thickness Burns
Chronic Suppurative Otitis Media Microbiology
Comparing CO2 Laser and Electrosurgical Treatments for Perianal Condyloma
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Health Canada Market Authorisation
Bacitracin is a branched cyclic dodecapeptide (12 AA) from Bacillus licheniformis. MW 1,422.71 Da (bacitracin A, 60-80%). Cyclic heptapeptide ring, linear pentapeptide tail, unique N-terminal thiazoline ring. Four D-amino acids. Applied topically 1-3x daily (OTC), ophthalmically q3-4h (Rx). IM injection for infants only: 900 units/kg/day. No meaningful systemic absorption from topical use.
Targets undecaprenyl pyrophosphate (C55-PP), essential for peptidoglycan biosynthesis. Bacitracin, complexed with Zn2+ (1:1:1 ternary complex), sequesters C55-PP, preventing dephosphorylation back to C55-P by undecaprenyl pyrophosphatase. Zn2+ coordinates thiazoline nitrogen, Glu-4 carboxyl, and pyrophosphate head group. Halts lipid carrier recycling, blocking peptidoglycan synthesis and causing osmotic lysis.
Marketed as Baciguent (topical), BACiiM (injection); combinations: Neosporin, Polysporin. Approved July 29, 1948. Pre-modern approval. Meleney et al. (1949): 270 cases of IM bacitracin showing efficacy with nephrotoxicity. Triple antibiotic ointment effective for surface infections. Indications: topical skin infections (OTC); ocular infections (Rx); infantile staphylococcal pneumonia/empyema (IM, restricted).
Vancomycin is marketed as Vancocin and Firvanq (approved 1958, with oral solution Firvanq approved 2018). It is the standard treatment for serious MRSA infections (bloodstream infections, endocarditis, pneumonia, bone infections) and is first-line for severe C. difficile colitis. Vancomycin requires therapeutic drug monitoring — blood levels must be checked regularly to ensure the dose is effective without causing kidney damage or hearing loss. The rise of vancomycin-resistant enterococci (VRE) and occasional vancomycin-intermediate S. aureus (VISA) strains represent ongoing challenges. Despite being nearly 70 years old, vancomycin remains irreplaceable for many serious infections, though newer alternatives like daptomycin and the lipoglycopeptides offer advantages in specific settings.
Zilucoplan is marketed as Zilbrysq (approved October 2023) for anti-acetylcholine receptor antibody-positive generalised myasthenia gravis in adults. Administered as a daily subcutaneous self-injection. In the RAISE trial, zilucoplan showed statistically significant improvements in both activities of daily living and quantitative muscle strength scores compared to placebo, with improvements evident from week one. Its key differentiator from existing complement inhibitors (eculizumab, ravulizumab) is the self-injectable format — those alternatives require hospital-based intravenous infusions. As with all complement inhibitors, patients require meningococcal vaccination before starting treatment due to increased susceptibility to meningococcal infection.
Daptomycin is marketed as Cubicin (approved September 2003). It is indicated for complicated skin and soft tissue infections and S. aureus bloodstream infections including right-sided endocarditis. Administered as a once-daily intravenous infusion. A key limitation is that daptomycin cannot be used for pneumonia — lung surfactant inactivates the drug. In the bacteraemia trial, daptomycin was non-inferior to vancomycin with significantly lower rates of kidney problems (11% versus 26%). Creatine kinase (CK) levels must be monitored during treatment, as daptomycin can cause muscle toxicity. Generics became available after patent expiry, significantly reducing cost.
This content is for informational purposes only and does not constitute medical advice. Always consult a qualified healthcare professional before making decisions about your health.
