Bacitracin Nephropathy

Bacitracin, a polypeptide produced by Bacillus subtilis, was discovered in 1945 by Johnson, Anker, and Meleney.1The early enthusiasm that followed the demonstration of its potent antibacterial action was soon dampened by reports of the nephrotoxic action of this and related polypeptide antibiotics2both in experimental animals and in man.3 In nearly every reported case, clinicians observed transient urinary abnormalities when bacitracin therapy was extended over a few days. The resulting proteinuria, cylindruria, azotemia, and occasional oliguria usually were self-limited, but at times necessitated termination of therapy. A review of the literature fails to reveal any fatality attributed to this antibiotic, so that the description of the renal lesion in a human being is lacking. The following case report is that of a patient with acute bacterial endocarditis. Renal failure unrelated to her primary disease developed in this woman after the institution of bacitracin therapy. REPORT OF