WordNet

a polypeptide antibiotic of known chemical structure effective against several types of Gram-positive organisms; usually applied locally
before the Christian era; used following dates before the supposed year Christ was born; "in 200 BC" (同)B.C., before Christ

Wikipedia preview

出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2016/04/25 03:31:07」(JST)

wiki en

Bacitracin is a mixture of related cyclic peptides produced by organisms of the licheniformis group of Bacillus subtilis var Tracy, first isolated in 1945. These peptides disrupt both gram positive and gram negative bacteria by interfering with cell wall and peptidoglycan synthesis.

Bacitracin is primarily used as a topical preparation (as it is can cause kidney damage when used internally).

While the use of any antibiotic can contribute to antibiotic resistance, localized topical applications are less frequently implicated than their systemic counterparts. However, antibiotics such as bacitracin have been shown to act as dermatological irritants and may slow healing.^[1]^[2]

History

The drug's unique name derives from the fact that it was isolated by John T. Goorley from a girl named Margaret Treacy (1936–1994):^[3] The surname was misspelled and the name was shortened to the more common spelling Tracy

One strain isolated from tissue debrided from a compound fracture of the tibia was particularly active. We named this growth-antagonistic strain for the patient, "Tracy I." When cell-free filtrates of broth cultures of this bacillus proved to possess strong antibiotic activity and to be non-toxic, further study seemed warranted. We have called this active principle "Bacitracin."^[4]

It was approved by FDA in 1948.

Synthesis

Bacitracin is synthesised via what is called nonribosomal peptide synthetases (NRPSs), which means that ribosomes are not involved in its synthesis.

bacABC is involved in synthesis.^[5]

Bacitracin is commercially manufactured by growing the bacteria Bacillus subtilis var Tracy I in a container of liquid growth medium. Over time, the bacteria synthesizes the antibiotic and secretes the antibiotic into the medium. The antibiotic is then extracted from the medium using chemical processes.

Composition

Bacitracin is composed of a mixture of related compounds with varying degrees of antibacterial activity. Notable fractions include bacitracin A, A1, B, B1, B2, C, D, E, F, G, and X.^[6] Bacitracin A has been found to have the most antibacterial activity. Bacitracin B1 and B2 have similar potencies and are approximately 90% as active as bacitracin A.^[7] Other bacitracin components including F and X do not appear to be extensively studied.

Spectrum of activity and susceptibility data

Bacitracin is a broad spectrum antibiotic. It targets both Gram-positive and Gram-negative bacteria, especially those that cause skin infections. The following represents susceptibility data for a few medically significant microorganisms.

Staphylococcus aureus – ≤0.03 μg/mL – 700 μg/mL
Staphylococcus epidermidis – 0.25 μg/mL – >16 μg/mL
Streptococcus pyogenes – 0.5 μg/mL – >16 μg/mL

^[8]

Mechanism of action

Bacitracin interferes with the dephosphorylation of C₅₅-isoprenyl pyrophosphate, a molecule that carries the building-blocks of the peptidoglycan bacterial cell wall outside of the inner membrane.^[9]

Some have claimed that bacitracin is a protein disulfide isomerase inhibitor, but this is disputed by in vitro studies.^[10]^[11]

Clinical use

A tube of bacitracin ointment for eyes

Bacitracin is used in human medicine as a polypeptide antibiotic and is "approved by the U.S. Food and Drug Administration (FDA) for use in chickens and turkeys," though use in animals contributes to antibiotic resistance.^[12]

As bacitracin zinc salt, in combination with other topical antibiotics (usually polymyxin B and neomycin) as an ointment ("triple antibiotic ointment," with a common brand name Neosporin), it is used for topical treatment of a variety of localized skin and eye infections, as well as for the prevention of wound infections. A non-ointment form of ophthalmic solution is also available for eye infections.^[13]

Although allergic cross reaction with sulfa drugs has been occasionally reported, bacitracin-containing topical preparations remain a possible alternative to silver sulfadiazine (Silvadene) for burn patients with a sulfa allergy.

3D Chemical Structure of Bacitracin

Bacitracin can also be bought in pure form for those with allergies to the polymyxin B and neomycin components of the combination product.

Bacitracin is also commonly used as an aftercare antibiotic on tattoos and circumcision. It is preferred over combination products such as Neosporin because of its fewer ingredients, which lowers chances of an allergic reaction.^[14]

Patch test

In 2005–06, it was the sixth-most-prevalent allergen in patch tests (9.2%).^[15]

It was voted Allergen of the Year in 2003 by the American Contact Dermatitis Society.^[16]

In infants, bacitracin is rarely administered intramuscularly for the treatment of staphylococcal pneumonia and empyema when due to organisms shown susceptible to bacitracin. This use is extremely limited, since bacitracin is nephrotoxic and the concentration of bacitracin in the blood must be followed closely.^[17]

Bacitracin can be used to distinguish Streptococcus pyogenes from other "strep" bacteria,^[18] with S. pyogenes being sensitive to bacitracin and others resistant. In this case bacitracin is used to distinguish S. pyogenes from other β-hemolytic streptococci.

It is also commonly used to distinguish Haemophilus influenzae colonies amongst respiratory flora, since H. influenzae is intrinsically resistant to bacitracin, colonies form within the zone of inhibition.

References

^ Spann, CT; Taylor, SC; Weinberg, JM (2004). "Topical antimicrobial agents in dermatology". Disease-a-month : DM 50 (7): 407–21. doi:10.1016/j.disamonth.2004.05.011. PMID 15280871.
^ Trookman, NS; Rizer, RL; Weber, T (2011). "Treatment of minor wounds from dermatologic procedures: A comparison of three topical wound care ointments using a laser wound model". Journal of the American Academy of Dermatology 64 (3 Suppl): S8–15. doi:10.1016/j.jaad.2010.11.011. PMID 21247665.
^ https://files.nyu.edu/jmm257/public/other/bacitracin.html
^ Johnson B, Anker H, Meleney F (1945). "Bacitracin: a new antibiotic produced by a member of the B. subtilis group".Science 102 (2650): 376–377.
^ Murphy, T.; Roy, I.; Harrop, A.; Dixon, K.; Keshavarz, T. (2007). "Effect of oligosaccharide elicitors on bacitracin a production and evidence of transcriptional level control". Journal of biotechnology 131 (4): 397–403. doi:10.1016/j.jbiotec.2007.07.943. PMID 17825450.
^ "Committee for Veterinary Medicinal Products Bacitracin." Ema.europa.eu. The European Agency for the Evaluation of Medicinal Products, June 1998. Web. 18 Jan. 2013
^ Bell, Robert G. "Preparative High-Performance Liquid Chromatographic Separation and Isolation of Bacitracin Components and Their Relationship to Microbiological Activity." Journal of Chromatography 590 (1992): 163–68. Web. 21 Aug. 2012.
^ http://www.toku-e.com/Assets/MIC/Bacitracin.pdf
^ Mechanism of Action of Bacitracin: Complexation with Metal Ion and C55-Isoprenyl Pyrophosphate K. John Stone and Jack L. Strominger
^ Karala, A. R.; Ruddock, L. W. (2010). "Bacitracin is not a specific inhibitor of protein disulfide isomerase". FEBS Journal 277 (11): 2454–2462. doi:10.1111/j.1742-4658.2010.07660.x. PMID 20477872.
^ Weston, B.; Wahab, N.; Roberts, T.; Mason, R. (2001). "Bacitracin inhibits fibronectin matrix assembly by mesangial cells in high glucose". Kidney international 60 (5): 1756–1764. doi:10.1046/j.1523-1755.2001.00991.x. PMID 11703593.
^ Antibiotic use on the farm hurts people—and doesn’t help the bottom line. Discover Magazine. Accessed on September 16, 2007.
^ http://www.healthgrades.com/drug-ratings/drug/information/1246/Triple%20Antibiotic
^ Tattoo Aftercare Contradictions
^ Zug KA, Warshaw EM, Fowler JF Jr, Maibach HI, Belsito DL, Pratt MD, Sasseville D, Storrs FJ, Taylor JS, Mathias CG, Deleo VA, Rietschel RL, Marks J. Patch-test results of the North American Contact Dermatitis Group 2005–2006. Dermatitis. 2009 May–Jun;20(3):149-60.
^ History of Allergen of the Year. American Contact Dermatitis Society. Accessed on April 24, 2014.
^ FDA-approved IM injection package insert for bacitracin.
^ "Streptococcus Group A Infections: Differential Diagnoses & Workup". Retrieved Sep 23, 2009.

UpToDate Contents

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1. 光線角膜炎 photokeratitis
2. 熱傷の局所治療：外用抗菌薬と被覆材 local treatment of burns topical antimicrobial agents and dressings
3. 口唇裂傷の評価およびマネージメント assessment and management of lip lacerations
4. 皮膚炎の概要 overview of dermatitis
5. 軽症熱傷の治療 treatment of minor thermal burns

English Journal

Inhibition of prolyl 4-hydroxylase, beta polypeptide (P4HB) attenuates temozolomide resistance in malignant glioma via the endoplasmic reticulum stress response (ERSR) pathways.

Sun S, Lee D, Ho AS, Pu JK, Zhang XQ, Lee NP, Day PJ, Lui WM, Fung CF, Leung GK.SourceCorresponding Author: Dr. Gilberto K. K. Leung, PhD, Division of Neurosurgery, Department of Surgery, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Queen Mary Hospital, 102 Pokfulam Rd., Pokfulam, Hong Kong. gilberto@hkucc.hku.hk.
Neuro-oncology.Neuro Oncol.2013 May;15(5):562-77. doi: 10.1093/neuonc/not005. Epub 2013 Feb 26.
Background Glioblastoma multiforme (GBM), the most aggressive malignant primary brain tumor of the central nervous system, is characterized by a relentless disease recurrence despite continued advancement in surgery, radiotherapy, and chemotherapy. Resistance to temozolomide (TMZ), a standard chemot
PMID 23444257

Trends in ophthalmic manifestations of methicillin-resistant Staphylococcus aureus (MRSA) in a northern California pediatric population.

Amato M, Pershing S, Walvick M, Tanaka S.SourceKaiser Permanente Department of Ophthalmology, Union City, California. Electronic address: malena_amato@hotmail.com.
Journal of AAPOS : the official publication of the American Association for Pediatric Ophthalmology and Strabismus / American Association for Pediatric Ophthalmology and Strabismus.J AAPOS.2013 Apr 24. pii: S1091-8531(13)00081-5. doi: 10.1016/j.jaapos.2012.12.151. [Epub ahead of print]
PURPOSE: To determine pediatric clinical trends of ocular and periocular methicillin-resistant Staphylococcus aureus (MRSA) in a large northern California healthcare system.METHODS: This study was a retrospective cross-sectional review of all pediatric cases (aged 0-18) with culture-positive ophthal
PMID 23623773

Japanese Journal

Establishment of Streptococcus mutans in infants induces decrease in the proportion of salivary α-haemolytic bacteria.

Kawaguchi Mamoru,Hoshino Tomonori,Ooshima Takashi,Fujiwara Taku
International Journal of Paediatric Dentistry / the British Paedodontic Society [and] the International Association of Dentistry for Children -(-), -, 2011-09-19
… To evaluate the changes caused by the establishment of S. mutans in the microbiota of the infant oral cavity, we monitored changes in the oral microbiota of two pre-dentate infants over a 3-year period and in a cross-sectional study of 40 nursery school-aged children by cultivation of saliva on nonselective blood agar, Mitis-Salivarius agar, and Mitis-Salivarius agar supplemented with bacitracin combined with identification of selected isolates. …
NAID 120003751856

皮膚感染症関連菌に対するゲンタマイシンの抗菌力と突然変異耐性菌出現頻度

岩木真生,野口雅久,中南秀将,笹津備規,伊藤正俊
YAKUGAKU ZASSHI 131(11), 1653-1659, 2011
… To investigate the effect of gentamicin used as an ointment, the antimicrobial susceptibilities against Staphylococcus aureus, coagulase-negative staphylococci, Streptococcus pyogenes, and Pseudomonas aeruginosa isolated from community and medical settings were studied and compared with other antibacterial agents such as fradiomycin, chloramphenicol, and bacitracin used as active ingredient for each ointment. … Bacitracin showed activity for St. pyogenes only. …
NAID 130001491121

Related Pictures

★リンクテーブル★

リンク元	「抗菌薬」「バシトラシン」「BC」

「抗菌薬」

Bacitracin
Systematic (IUPAC) name
	(4R)-4-[(2S)-2-({2-[(1S)-1-amino-2-methylbutyl]- 4,5-dihydro-1,3-thiazol-5-yl}formamido)-4-methylpentanamido]-4-{[(1S)- 1-{[(3S,6R,9S,12R,15S,18R,21S)- 18-(3-aminopropyl)-12-benzyl-15-(butan-2-yl)-3-(carbamoylmethyl)- 6-(carboxymethyl)-9-(1H-imidazol-5-ylmethyl)-2,5,8,11,14,17,20- heptaoxo-1,4,7,10,13,16,19-heptaazacyclopentacosan-21-yl]carbamoyl}- 2-methylbutyl]carbamoyl}butanoic acid
Clinical data
Trade names	Baciim
AHFS/Drugs.com	monograph
Pregnancy; category	AU: D; US: C (Risk not ruled out); ;
Routes of; administration	Topical, intramuscular
Legal status
Legal status	AU: S4 (Prescription only); US: OTC for topical administration; Rx-only for injection;
Identifiers
CAS Number	1405-87-4
ATC code	D06AX05 (WHO) J01XX10 (WHO) R02AB04 (WHO) QA07AA93 (WHO)
PubChem	CID 439542
DrugBank	DB00626
ChemSpider	10481985
UNII	58H6RWO52I
KEGG	D00128
ChEMBL	CHEMBL1200558
Chemical data
Formula	C66H103N17O16S
Molar mass	1422.69 g/mol
	SMILES O=C(O)C[C@H]3NC(=O)[C@H](Cc1cncn1)NC(=O)[C@@H](Cc2ccccc2)NC(=O)[C@@H](NC(=O)[C@@H](CCCN)NC(=O)[C@H](CCCCNC(=O)[C@H](CC(N)=O)NC3=O)NC(=O)[C@@H](NC(=O)[C@@H](CCC(=O)O)NC(=O)[C@H](CC(C)C)NC(=O)C4N=C(SC4)\nC(N)C(C)CC)C(C)CC)C(C)CC ;
	InChI InChI=1S/C66H103N17O16S/c1-9-35(6)52(69)66-81-48(32-100-66)63(97)76-43(26-34(4)5)59(93)74-42(22-23-50(85)86)58(92)83-53(36(7)10-2)64(98)75-40-20-15-16-25-71-55(89)46(29-49(68)84)78-62(96)47(30-51(87)88)79-61(95)45(28-39-31-70-33-72-39)77-60(94)44(27-38-18-13-12-14-19-38)80-65(99)54(37(8)11-3)82-57(91)41(21-17-24-67)73-56(40)90/h12-14,18-19,31,33-37,40-48,52-54H,9-11,15-17,20-30,32,67,69H2,1-8H3,(H2,68,84)(H,70,72)(H,71,89)(H,73,90)(H,74,93)(H,75,98)(H,76,97)(H,77,94)(H,78,96)(H,79,95)(H,80,99)(H,82,91)(H,83,92)(H,85,86)(H,87,88)/t35?,36?,37?,40-,41+,42+,43-,44+,45-,46-,47+,48?,52?,53-,54-/m0/s1 ; Key:CLKOFPXJLQSYAH-NVOBBBONSA-N ;
(what is this?) (verify)

　　[★]

英: antibacterial drug, antibacterial
関: 抗生剤、薬理学、抗菌薬一覧、抗細菌薬

first aid step 1 2006 p.165

定義

細菌/微生物に静菌作用、殺菌作用を示す物質。結果として、人において病原性を除去する目的で使用される。
このうち、微生物によって産生される物質を抗生物質と呼ぶ

作用機序による分類

細胞壁合成阻害：βラクタム系抗菌薬(ペニシリン系抗菌薬、セフェム系抗菌薬、モノバクタム系抗菌薬、カルバペネム系抗菌薬)
核酸合成阻害　：ニューキノロン系抗菌薬、メトロニダゾール
タンパク質合成阻害

30S：アミノグリコシド系抗菌薬、テトラサイクリン系抗菌薬
50S：マクロライド系抗菌薬、クリンダマイシン、クロラムフェニコール、ストレプトグラミン系抗菌薬、オキソゾリニドン系抗菌薬(リゾネリド)

代謝拮抗：サルファ剤(サルファメソキサゾール、トリメトプリム)

first aid step 1 2006 p.165

	Mechanism of action	Drugs
1	Block cell wall synthesis by inhibition of peptidoglycan cross-linking	penicillin, ampicillin, ticarcillin, piperacillin, imipenem, aztreonam, cephalosporins
2	Block peptidoglycan synthesis	bacitracin, vancomycin, cycloserine
3	Disrupt bacterial/fungal cell membranes	polymyxins
4	Disrupt fungal cell membranes	amphotericin B, nystatin, fluconazole/azoles
5	Block nucleotide synthesis	sulfonamides, trimethoprim
6	Block DNA topoisomerases	quinolones
7	Block mRNA synthesis	rifampin
8	Block protein synthesis at 50S ribosomal subunit	chloramphenicol, erythromycin/macrolides, lincomycin, clindamycin, streptogramins (quinupristin, dalfopristin), linezolid
9	Block protein synthesis at 30S ribosomal subunit	aminoglycosides, tetracyclines, spectinomycin 　ATuSi　→　あつし

薬物動態

濃度依存性：アミノグリコシド系抗菌薬、ニューロキノロン系抗菌薬
時間依存性：βラクタム系抗菌薬

治療期間

小児

尾内一信 ; 第 39 回日本小児感染症学会教育講演 2 小児感染症の抗菌薬療法 -耐性菌時代の適正使用-

感染臓器・臨床診断	原因菌	投与期間（抗菌薬）
髄膜炎	インフルエンザ菌	7-10日
	肺炎球菌	10-14日
	髄膜炎菌	7-10日
	GBS，腸内細菌，リステリア	21日
中耳炎	＜2 歳	10日
中耳炎	2 歳≦	5-7日
咽頭炎	A 群連鎖球菌	10日(ペニシリン系薬)
咽頭炎	A 群連鎖球菌	5日(セフェム系薬)
肺炎	肺炎球菌，インフルエンザ菌	解熱後3-4日
	黄色ブドウ球菌	3-4週間
	マイコプラズマ，クラミジア	10-21日
腎臓、膀胱炎、腎盂腎炎	大腸菌，プロテウス，腸球菌	3日
腎臓、膀胱炎、腎盂腎炎	大腸菌，プロテウス，腸球菌	14日
骨髄炎	黄色ブドウ球菌	21日
骨髄炎	連鎖球菌，インフルエンザ菌	14日

主要な感染症の抗菌薬投与期間

感染レジマニュ p.27

骨	骨髄炎		4-6週
耳鼻咽喉	中耳炎		5-7日
	副鼻腔炎		5-14日
	A群溶連菌咽頭炎		10日
肺	肺炎	肺炎球菌	7-10日 or 解熱後3日間
		インフルエンザ菌	10-14日
		マイコプラズマ	14日(7-10日)
		レジオネラ	21日
	肺化膿症		28-42日
心臓	感染性心内膜炎	α連鎖球菌	2-4週
		黄色ブドウ球菌	4-6週
消化管	腸炎	赤痢菌	3日
		チフス	14日(5-7日)
		パラチフス
	腹膜炎	特発性	5日
		二次性	10-14日
胆肝膵	肝膿瘍	細菌性	4-8週
		アメーバ性	10日
尿路	膀胱炎		3日
	急性腎盂腎炎		14日(7-10日)
	急性腎盂腎炎・再発		6週
	慢性前立腺炎		1-3ヶ月
髄腔	髄膜炎	インフルエンザ菌	7-10日
		髄膜炎菌
		肺炎球菌	10-14日
		リステリア	21日
敗血症	敗血症	コアグラーゼ陰性ブドウ球菌	5-7日
		黄色ブドウ球菌	28日(14日)
		グラム陰性桿菌	14日(7-14日)
		カンジダ	血液培養陰性化後, 14日

ソース不明

シャント感染：黄色ブドウ球菌：頭蓋内デバイスの感染の場合、髄液培養陰性+10日間

妊婦に避けるべき抗菌薬

Antibiotics to avoid in pregnancy
Sulfonamides––kernicterus.
Aminoglycosides––ototoxicity.
Fluoroquinolones––cartilage damage.
Erythromycin––acute cholestatic hepatitis in mom

(and clarithromycin––embryotoxic).

Metronidazole––mutagenesis.
Tetracyclines––discolored teeth, inhibition of bone growth.
Ribavirin (antiviral)––teratogenic.
Griseofulvin (antifungal)––teratogenic.
Chloramphenicol––“gray baby.”
SAFE Moms Take Really Good Care.

使っても良い

YN.H-24

βラクタム系
エリスロマイシン、アジスロマイシン

参考

抗菌薬インターネットブック

まとまっていてよい

http://www.antibiotic-books.jp

抗菌薬一覧

「バシトラシン」

　　[★]

英: bacitracin
商: バラマイシン
関: 連鎖球菌

グラム陽性菌に有効な抗菌物質の一つ
細胞膜に作用する
Bacillus subtilis Tracyより分離されたポリペプチド抗生物質
腎毒性が強く、腸から吸収されずに局所で作用するのでトローチ剤として使われている
β溶血性を示すβ溶血性連鎖球菌の中でA群連鎖球菌はバシトラシンに対して強い感受性を示す→A群β溶血性連鎖球菌の同定試験に用いられる(バシトラシン試験)

感受性　：Streptococcus pyogenes
非感受性：Streptococcus agalactiae

「BC」

　　[★] バシトラシン bacitracin

[1] Spann, CT; Taylor, SC; Weinberg, JM (2004). "Topical antimicrobial agents in dermatology". Disease-a-month : DM 50 (7): 407–21. doi:10.1016/j.disamonth.2004.05.011. PMID 15280871.

[2] Trookman, NS; Rizer, RL; Weber, T (2011). "Treatment of minor wounds from dermatologic procedures: A comparison of three topical wound care ointments using a laser wound model". Journal of the American Academy of Dermatology 64 (3 Suppl): S8–15. doi:10.1016/j.jaad.2010.11.011. PMID 21247665.

[3] ttps://files.nyu.edu/jmm257/public/other/bacitracin.html

[4] Johnson B, Anker H, Meleney F (1945). "Bacitracin: a new antibiotic produced by a member of the B. subtilis group".Science 102 (2650): 376–377.

[5] Murphy, T.; Roy, I.; Harrop, A.; Dixon, K.; Keshavarz, T. (2007). "Effect of oligosaccharide elicitors on bacitracin a production and evidence of transcriptional level control". Journal of biotechnology 131 (4): 397–403. doi:10.1016/j.jbiotec.2007.07.943. PMID 17825450.

[6] "Committee for Veterinary Medicinal Products Bacitracin." Ema.europa.eu. The European Agency for the Evaluation of Medicinal Products, June 1998. Web. 18 Jan. 2013

[7] Bell, Robert G. "Preparative High-Performance Liquid Chromatographic Separation and Isolation of Bacitracin Components and Their Relationship to Microbiological Activity." Journal of Chromatography 590 (1992): 163–68. Web. 21 Aug. 2012.

[8] ttp://www.toku-e.com/Assets/MIC/Bacitracin.pdf

[9] Mechanism of Action of Bacitracin: Complexation with Metal Ion and C55-Isoprenyl Pyrophosphate K. John Stone and Jack L. Strominger

[10] Karala, A. R.; Ruddock, L. W. (2010). "Bacitracin is not a specific inhibitor of protein disulfide isomerase". FEBS Journal 277 (11): 2454–2462. doi:10.1111/j.1742-4658.2010.07660.x. PMID 20477872.

[11] Weston, B.; Wahab, N.; Roberts, T.; Mason, R. (2001). "Bacitracin inhibits fibronectin matrix assembly by mesangial cells in high glucose". Kidney international 60 (5): 1756–1764. doi:10.1046/j.1523-1755.2001.00991.x. PMID 11703593.

[disc-12] Antibiotic use on the farm hurts people—and doesn’t help the bottom line. Discover Magazine. Accessed on September 16, 2007.

[13] ttp://www.healthgrades.com/drug-ratings/drug/information/1246/Triple%20Antibiotic

[14] Tattoo Aftercare Contradictions

[15] Zug KA, Warshaw EM, Fowler JF Jr, Maibach HI, Belsito DL, Pratt MD, Sasseville D, Storrs FJ, Taylor JS, Mathias CG, Deleo VA, Rietschel RL, Marks J. Patch-test results of the North American Contact Dermatitis Group 2005–2006. Dermatitis. 2009 May–Jun;20(3):149-60.

[16] History of Allergen of the Year. American Contact Dermatitis Society. Accessed on April 24, 2014.

[17] FDA-approved IM injection package insert for bacitracin.

[urlStreptococci-18] "Streptococcus Group A Infections: Differential Diagnoses & Workup". Retrieved Sep 23, 2009.

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bacitracin