From the Guidelines
You can generally use bacitracin if you have a penicillin allergy, as cross-reactivity between penicillin and bacitracin is extremely rare. Bacitracin is a topical antibiotic that works differently from penicillin and is not in the same antibiotic family 1. According to a 2022 practice parameter update on drug allergy, approximately 10% of patients report a history of reacting to a penicillin class antibiotic, but when evaluated, 90% of these individuals tolerate penicillins and are labeled allergic unnecessarily 1.
Key Considerations
- Bacitracin is typically available as an ointment and is applied directly to minor cuts, scrapes, or burns 1-3 times daily after cleaning the area with mild soap and water.
- A thin layer should be spread on the affected area and covered with a sterile bandage if needed.
- While bacitracin is generally safe for people with penicillin allergies, some individuals may rarely develop a contact dermatitis reaction to bacitracin itself 1.
- If you notice increasing redness, itching, or rash after application, discontinue use and consult a healthcare provider.
Important Notes
- For more serious infections requiring systemic antibiotics, you should always inform your healthcare provider about your penicillin allergy so they can prescribe appropriate alternatives 1.
- A proactive effort should be made to delabel penicillin allergy whenever possible, as it can lead to improved antibiotic selection and decreased use of broad-spectrum antibiotics 1.
From the Research
Penicillin Allergy and Bacitracin Use
- There is no direct information in the provided studies about the use of bacitracin in patients with penicillin allergy.
- However, the studies discuss the evaluation and management of penicillin allergy, and the use of other antibiotics in penicillin-allergic patients 2, 3, 4, 5.
- Bacitracin is a topical antibiotic, and its use may not be directly related to penicillin allergy, but it is essential to consider the patient's medical history and potential allergies before using any antibiotic 2, 3.
Evaluation of Penicillin Allergy
- The evaluation of penicillin allergy is crucial to determine the risk of an allergic reaction and to guide the use of other antibiotics 2, 4, 5.
- Patients with a low-risk history of penicillin allergy can undergo direct amoxicillin challenge, while those with a moderate-risk history can be evaluated with penicillin skin testing 2.
- The use of broad-spectrum antibiotics in penicillin-allergic patients can increase the risk of antimicrobial resistance and adverse events 2, 3.
Use of Other Antibiotics in Penicillin-Allergic Patients
- Cephalosporins can be used safely in patients with a history of penicillin allergy, except for those with a history of anaphylaxis or severe allergic reactions 3, 6.
- The cross-reactivity between penicillins and cephalosporins is lower than previously reported, and the use of third- or fourth-generation cephalosporins carries a negligible risk of cross-allergy 6.
- Other antibiotics, such as fluoroquinolones and macrolides, can be used in penicillin-allergic patients, but the risk of cross-reactivity should be considered 4.