Bacitracin is NOT Appropriate for Hand, Foot, and Mouth Disease
Bacitracin should not be used to treat hand, foot, and mouth disease (HFMD) because HFMD is a viral infection caused by enteroviruses, and bacitracin is an antibiotic that only works against bacteria. 1, 2
Why Antibiotics Don't Work for HFMD
HFMD is caused by viruses, not bacteria. The primary causative agents are enteroviruses including coxsackievirus A16, enterovirus 71 (EV-A71), coxsackievirus A6, and coxsackievirus A10. 1, 2, 3
Antibiotics like bacitracin have no antiviral activity and will not shorten the duration of illness, reduce symptoms, or prevent complications. 4
Currently, there are no effective antiviral therapies available to treat enterovirus infections that cause HFMD. 3
What HFMD Actually Is
HFMD is a self-limiting viral illness that predominantly affects children under 5 years of age, characterized by fever, vesicular rashes on hands, feet, and buttocks, and ulcers in the oral mucosa. 1, 2
Most infections are asymptomatic or cause only mild symptoms that resolve without specific medical treatment. 1
A small proportion of children may develop severe complications including meningitis, encephalitis, acute flaccid paralysis, and pulmonary edema, particularly with EV-A71 infections. 2, 3, 5
When Bacitracin Might Be Considered (But Still Not for HFMD Itself)
Topical antibiotics like bacitracin are only appropriate for bacterial skin infections such as impetigo, where mupirocin is actually the preferred topical agent. 4
Bacitracin should be avoided as a routine topical agent because it is a known allergen that can cause allergic contact dermatitis, particularly when used under occlusion (such as with adhesive bandages). 4
If secondary bacterial infection of HFMD lesions occurs (which is uncommon), systemic antibiotics targeting Staphylococcus aureus and Streptococcus pyogenes would be more appropriate than topical bacitracin. 4
Appropriate Management of HFMD
Supportive care is the mainstay of treatment: adequate hydration, pain control for oral ulcers, and fever management. 2, 3
Monitor for severe complications in children under 3 years of age, including neurological symptoms that may indicate brain stem encephalitis or meningoencephalitis. 3, 5
No topical antimicrobial agents should be applied to HFMD lesions with the aim of accelerating healing. 6