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Bacitracin

Bacitracin is a mixture of related cyclic polypeptides produced by organisms of the licheniformis group of Bacillus subtilis var Tracy. As a toxic and difficult-to-use antibiotic, bacitracin doesn't work well orally. However, it is very effective topically. more...

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Mechanism of action

Bacitracin interferes with the dephosphorylation of the C55-isoprenyl pyrophosphate, a molecule which carries the building blocks of the peptidoglycan bacterial cell wall outside of the inner membrane .

Clinical use

As bacitracin zinc salt, and in combination with other topical antibiotics (usually polymyxin B and neomycin), it is used in ointment form for topical treatment of a variety of localized skin and eye infections, as well as for the prevention of wound infections. This ointment is sold in the United States under the brand name Neosporin.

In infants, it is sometimes administered intramuscularly for the treatment of pneumonias. This formulation is sold under the brand name BaciimĀ®.

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Bacitracin testing for Group A streptococcal pharyngitis
From Archives of Pathology & Laboratory Medicine, 8/1/03 by Dale, Jane C

To the Editor.-Previously, we reported on the laboratory practices used to identify group A streptococci among 790 customers of the College of American Pathologists Excel Proficiency Testing Program, a program targeted primarily at physician office laboratories and small hospital laboratories.1 In our report, the majority (57.9%) of respondents who performed bacitracin testing applied the disk to a primary plate. Because we were unable to distinguish between those who used selective media primary plates and those who used blood agar (BA) primary plates, we conducted a follow-up survey of current Excel Proficiency Testing subscribers and asked, "What method do you use to confirm group A streptococcus on throat cultures?" Among 1086 respondents, 557 (51.3%) used the bacitracin test and applied the disks to selective agar primary plates, 390 (35.9%) applied the disks to BA primary plates, and 45 (4.1%) applied the disks to subculture plates. Other methods, not specified, were used by 94 (8.7%).

This finding confirms that most office laboratories do not perform subcultures for group A streptococci, presumably because it adds another day to the testing process and is categorized as a highly complex procedure. Although selective media primary plates have been shown to effectively identify group A [beta]-hemolytic streptococci,2 false negatives may occur if BA primary plates are used. Overgrowth with normal flora can obscure the inhibition of group A [beta]-hemolytic streptococci, and too few organisms may be present to accurately assess inhibition zones. Accordingly, the use of BA primary plates for the presumptive diagnosis of group A [beta]-hemolytic streptococci generally is not recommended,3 although this has been disputed.4 We believe additional studies are needed to clarify this issue. In the absence of definitive studies, we recommend that if group A [beta]-hemolytic streptococci identification is performed with a bacitracin disk on a primary plate (not a subculture), the plate used should be a selective media plate rather than a BA plate.

1. Dale JC, Novak R, Higgens P, Wahl E. Testing for group A streptococci-practices reported by 790 laboratories enrolled in the College of American Pathologists Excel Proficiency Testing Program. Arch Pathol Lab Med. 2002;126:1467-1469.

2. Kurzynski T, Meise C, Daggs R, Helstad A. Improved reliability of the primary plate bacitracin disc test on throat cultures with sulfamethoxazole-trimethoprim (SXT) blood agar plates. J Clin Microbiol. 1979;9:144-146.

3. Murray PR, Wold AD, Hall M, Washington JA. Bacitracin differentiation for presumptive identification of group A [beta]-hemolytic streptococci: comparison of primary and purified plate testing. J Pediatr. 1976;89:576-579.

4. Roddy OF Jr, Clegg HW, Martin ES, Swetenburg RL, Koonce EW. Comparison of throat culture methods for the recovery of group A streptococci in a pediatric office setting. JAMA. 1995;274:1863-1865.

JANE C. DALE, MD

Department of Laboratory Medicine and Pathology

Mayo Clinic

Rochester, MN 55905

Copyright College of American Pathologists Aug 2003
Provided by ProQuest Information and Learning Company. All rights Reserved

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