Mupirocin vs bacitracin

[flightdoc09]

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When/why do you prefer mupirocin over bacitracin?

I am EM and use a lot of bacitracin. For burns, for generic application on lacerations after repair, or on road rash, etc. I was recently talking to ID, and they were telling me that dermatology hates bacitracin. I know y'all hate neomycin/Neosporin, but do y'all hate bacitracin as well? I did read somewhere trying to figure it out that there is some potential cross reactivity between baci and neo - so you might get a hypersenitivity reaction with it, but less common than neo.

Also read the mupirocin resistance is rising, so best to stick to bacitracin for routine use, and mupirocin only for MRSA specific coverage.

She also told me that y'all like to do a lot more topical treatments than systemic for minor skin infections, but she didn't go into more detail.

 

[sloh]

For clean surgical wounds, lacerations, or road rash, the dermatological gold standard is plain white petrolatum (Vaseline or Aquaphor) to maintain a moist healing environment, as studies consistently show topical antibiotics offer no statistically significant reduction in infection rates over plain petrolatum.

Dermatology's disdain for bacitracin and neomycin stems from their high rates of sensitization. Neomycin is a notorious contact allergen, and bacitracin is not far behind. When providers see a wound turning red, itchy, and inflamed a few days after applying these ointments, it is frequently misdiagnosed as a worsening infection (or cellulitis) when it is actually allergic contact dermatitis.

 

[flightdoc09]

For clean surgical wounds, lacerations, or road rash, the dermatological gold standard is plain white petrolatum (Vaseline or Aquaphor) to maintain a moist healing environment, as studies consistently show topical antibiotics offer no statistically significant reduction in infection rates over plain petrolatum.

Dermatology's disdain for bacitracin and neomycin stems from their high rates of sensitization. Neomycin is a notorious contact allergen, and bacitracin is not far behind. When providers see a wound turning red, itchy, and inflamed a few days after applying these ointments, it is frequently misdiagnosed as a worsening infection (or cellulitis) when it is actually allergic contact dermatitis.

Thanks. I remember when I was on the burn/trauma unit in residency just totally slathering bacitracin on people day after day. Originally it was silvadene, but that fell out of favor after my first year or two of residency.

I wonder if it would be reasonable to put bacitracin on when leaving the ED, and then instruct them for the following days to just use vaseline or aquaphor. Give just one day to protect the wound with antimicrobial properties while it seals up a bit before switching to something plain for the healing moisture?

Thanks for the info.

 

[Dral]

Thanks. I remember when I was on the burn/trauma unit in residency just totally slathering bacitracin on people day after day. Originally it was silvadene, but that fell out of favor after my first year or two of residency.

I wonder if it would be reasonable to put bacitracin on when leaving the ED, and then instruct them for the following days to just use vaseline or aquaphor. Give just one day to protect the wound with antimicrobial properties while it seals up a bit before switching to something plain for the healing moisture?

Thanks for the info.

I would say no. It just takes the one application to get a contact allergy response. If anything, see about getting a tube of Mupirocin on hand and use that. We have a tube of Mupirocin in clinic that we use for rare situations when we do that. Otherwise with procedures - just straight up petrolatum as sloh mentioned.

 

[flightdoc09]

What are y'all's thoughts on bacitracin for burns? Specifically partial thickness burns? Most burn units will slather it on for days, sometimes weeks, until the skin re-epithelializes. And then I think they'll switch to vaseline. Usually in the ED, if we're deroofing burns we're sending the patient home with at least a week of bacitracin until they can follow up with their PCP or a burn clinic.

 

[sloh]

Burn units and emergency departments are increasingly transitioning to plain petrolatum combined with non-adherent layers (e.g., silicone mesh or petrolatum gauze) for uncomplicated partial-thickness burns. When a burn presents a genuine clinical risk of infection, facilities generally bypass bacitracin in favor of broad-spectrum, sustained-release antimicrobials with lower hypersensitivity risks, such as silver-impregnated dressings (e.g., Aquacel Ag) or specialized absorptive hydrocolloids.

 

[flightdoc09]

Burn units and emergency departments are increasingly transitioning to plain petrolatum combined with non-adherent layers (e.g., silicone mesh or petrolatum gauze) for uncomplicated partial-thickness burns. When a burn presents a genuine clinical risk of infection, facilities generally bypass bacitracin in favor of broad-spectrum, sustained-release antimicrobials with lower hypersensitivity risks, such as silver-impregnated dressings (e.g., Aquacel Ag) or specialized absorptive hydrocolloids.

I haven't noticed a shift yet. When I call the local burn center for consults they usually recommend polysporin, though most burn docs are still recommending bacitracin. I think for superficial and superficial partial vaseline may be becoming more common, but for deep partial I think topical bacitracin is still most peoples' go to.

Though this could be regional variance, and certainly it takes time for evidence to catch up with practice. Wasn't that long ago that silvadene was still the standard. I'll start asking around and looking into it more. Thanks.