To reduce the development of drug-resistant bacteria and maintain the effectiveness of bacitracin for injection and other antibacterial drugs, bacitracin for injection should be used only to treat or prevent infections that are proven or strongly suspected to be caused by bacteria.

For Intramuscular Use

Bacitracin for Injection, USP is a sterile antibiotic for intramuscular administration. Bacitracin is derived from cultures of Bacillus subtilis (Tracey). It is a white to pale buff, hygroscopic powder, odorless or having a slight odor. It is freely soluble in water; insoluble in acetone, chloroform, and ether. While soluble in alcohol, methanol, and glacial acetic acid, there is some insoluble residue. It is precipitated from its solutions and inactivated by many of the heavy metals.

The structural formula is:

The molecular formula is: C66H103N17O16 S. Bacitracin is comprised of a polypeptide complex and bacitracin A is the major component in this complex. The molecular weight of bacitracin A is 1422.71.

Bacitracin exerts pronounced antibacterial action in vitro against a variety of gram-positive and a few gram-negative organisms. However, among systemic diseases, only staphylococcal infections qualify for consideration of bacitracin therapy. Bacitracin is assayed against a standard and its activity is expressed in units, 1 mg having a potency of not less than 50 units.

Susceptibility plate testing: If the Kirby-Bauer method of disk susceptibility is used, a 10 unit bacitracin disk should give a zone of over 13 mm when tested against a bacitracin-susceptible strain of Staphylococcus aureus. Absorption of bacitracin following intramuscular injection is rapid and complete. A dose of 200 or 300 units/kg every 6 hours gives serum levels of 0.2 to 2 mcg/mL in individuals with normal renal function. The drug is excreted slowly by glomerular filtration. It is widely distributed in all body organs and is demonstrable in ascitic and pleural fluids after intramuscular injection.

In accordance with the statements in the "Warning Box", the use of intramuscular Bacitracin for Injection, USP is limited to the treatment of infants with pneumonia and empyema caused by staphylococci shown to be susceptible to the drug.

To reduce the development of drug-resistant bacteria and maintain the effectiveness of Bacitracin for Injection, USP and other antibacterial drugs, Bacitracin for Injection, USP should be used only to treat or prevent infections that are proven or strongly suspected to be caused by susceptible bacteria. When culture and susceptibility information are available, they should be considered in selecting or modifying antibacterial therapy. In the absence of such data, local epidemiology and susceptibility patterns may contribute to the empiric selection of therapy.

This drug is contraindicated in those individuals with a history of previous hypersensitivity or toxic reaction to it.

Clostridium difficile associated diarrhea (CDAD) has been reported with use of nearly all antibacterial agents and may range in severity from mild diarrhea to fatal colitis. Treatment with antibacterial agents alters the normal flora of the colon leading to overgrowth of C. difficile.

C. difficile produces toxins A and B which contribute to the development of CDAD. Hypertoxin producing strains of C. difficile cause increased morbidity and mortality, as these infections can be refractory to antimicrobial therapy and may require colectomy. CDAD must be considered in all patients who present with diarrhea following antibacterial use. Careful medical history is necessary since CDAD has been reported to occur over two months after the administration of antibacterial agents.

If CDAD is suspected or confirmed, ongoing antibacterial use not directed against C. difficile may need to be discontinued. Appropriate fluid and electrolyte management, protein supplementation, antibacterial treatment of C. difficile, and surgical evaluation should be instituted as clinically indicated.

See "Warning Box" for precautions in regard to kidney toxicity associated with intramuscular use of bacitracin.

Adequate fluid intake should be maintained orally, or if necessary, by parenteral method.

As with other antibiotics, use of this drug may result in overgrowth of nonsusceptible organisms, including fungi. If superinfection occurs, appropriate therapy should be instituted.

Prescribing bacitracin in the absence of a proven or strongly suspected bacterial infection or a prophylactic indication is unlikely to provide benefit to the patient and increases the risk of the development of drug-resistant bacteria.

There have been reports of anaphylaxis and/or allergic contact dermatitis in patients exposed to bacitracin for injection in non-approved indications.

Nephrotoxic reactions—Albuminuria, cylindruria, azotemia. Rising blood levels without any increase in dosage.

Other reactions—Nausea and vomiting. Pain at site of injection. Skin rashes.

TO BE ADMINISTERED INTRAMUSCULARLY ONLY

Infant dose: For infants under 2500 grams—900 units/kg/24 hours in 2 or 3 divided doses. For infants over 2500 grams—1,000 units/kg/24 hours, in 2 or 3 divided doses. Intramuscular injections of the solution should be given in the upper outer quadrant of the buttocks, alternating right and left and avoiding multiple injections in the same region because of the transient pain following injection.

Bacitracin for Injection, USP is available in a vial containing 50,000 units bacitracin.

NDC 17478-608-30         Carton of 1 vial

Store the unreconstituted product in a refrigerator 2° to 8°C (36° to 46°F).

Rx Only

AKORN

Manufactured By:
Akorn, Inc.
Lake Forest, IL 60045

BC00N Rev. 10/17

Principal Display Panel Text for Container Label:

NDC 17478-608-30

Bacitracin

for Injection, USP

50,000 Units Per Vial

For Intramuscular Use

Sterile

Rx only

Principal Display Panel Text for Carton Label:

NDC 17478-608-30

Bacitracin

for Injection, USP

50,000 Units Per Vial

For Intramuscular Use

Sterile

1 x 50,000 Unit Vial

Rx only Akorn Logo