Provider Briefing: The Bacitracin/Polymyxin B Ophthalmic Shortage

The ongoing shortage of Bacitracin/Polymyxin B ophthalmic ointment continues to present challenges for prescribers across specialties. Whether you're in ophthalmology, optometry, primary care, or urgent care, this shortage affects how you manage bacterial eye infections. This briefing provides a comprehensive update on the timeline, prescribing implications, alternative therapies, and tools to help your patients access treatment.

Shortage Timeline

The current shortage traces back to a key supply disruption:

• July 2024: Padagis (formerly Perrigo) temporarily discontinued production of bacitracin ophthalmic ointment in 3.5-gram tubes — one of the most widely prescribed formulations.
• Late 2024 – 2025: Remaining manufacturer stock was gradually depleted. The ASHP and FDA added bacitracin ophthalmic to their active shortage lists. Sporadic availability was reported at some pharmacies, but supply remained inconsistent nationwide.
• Early 2026: The shortage persists. Padagis estimates production will resume by October 2026, though this timeline has not been independently confirmed and could shift.

Additionally, the FDA previously requested that all manufacturers of bacitracin for injection voluntarily withdraw their products from the market due to nephrotoxicity concerns. While this affects a different formulation, it further constrains the overall bacitracin supply landscape.

Prescribing Implications

The shortage has several practical implications for prescribers:

Formulary Considerations

Bacitracin/Polymyxin B ophthalmic ointment (Polysporin Ophthalmic, AK-Poly-Bac, Polycin) has been a first-line option for superficial bacterial eye infections due to its broad-spectrum coverage, favorable safety profile, and ointment formulation that provides extended contact time. With supply constraints, prescribers should consider pre-emptively selecting alternatives for new prescriptions.

Impact on Patient Compliance

Patients who present prescriptions at the pharmacy and are told the medication is unavailable may experience delays in starting treatment. For acute bacterial conjunctivitis or post-procedural prophylaxis, such delays can lead to worsened outcomes or unnecessary follow-up visits.

Prescribing Alternatives

The following alternatives are generally available and appropriate substitutes depending on the clinical scenario:

1. Erythromycin Ophthalmic Ointment (0.5%)
   • Macrolide antibiotic with primarily gram-positive coverage
   • Ointment formulation similar to Bacitracin/Polymyxin B
   • Safe for neonatal prophylaxis
   • Widely available; typically $15-$30 with discount programs
   • Limitation: Limited gram-negative activity
2. Tobramycin Ophthalmic (Tobrex) — drops or ointment
   • Aminoglycoside with excellent gram-negative coverage including Pseudomonas
   • Available as 0.3% drops and ointment
   • Typically $15-$40 with discount programs
   • Limitation: Less effective against some gram-positive organisms
3. Ciprofloxacin Ophthalmic (Ciloxan) — drops or ointment
   • Fluoroquinolone with broad-spectrum gram-positive and gram-negative coverage
   • Preferred for corneal ulcers and more severe infections
   • Typically $10-$30 with discount programs
   • Limitation: May cause corneal precipitates (usually resolve); resistance concerns with overuse
4. Levofloxacin Ophthalmic (1.5%)
   • Newer fluoroquinolone with enhanced gram-positive coverage
   • Drop formulation only
   • Appropriate for bacterial conjunctivitis and corneal ulcers

For a patient-facing comparison, you can direct patients to our guide on alternatives to Bacitracin/Polymyxin B.

Current Availability Picture

Availability varies significantly by region and pharmacy type:

• Chain pharmacies (CVS, Walgreens, Rite Aid): Sporadic availability; often first to run out due to high patient volumes
• Independent pharmacies: May have better access through diverse wholesaler relationships
• Compounding pharmacies: Some can prepare equivalent ophthalmic ointment formulations, though these require sterile compounding capabilities (USP 797 compliance)
• Hospital pharmacies: May have reserved stock for inpatient/surgical use

Cost and Access Considerations

When Bacitracin/Polymyxin B is available, costs are as follows:

• Retail cash price: $50-$70 per 3.5g tube
• With discount coupons: $13-$25 (SingleCare, GoodRx)
• Insurance coverage: Typically Tier 1-2 on most formularies; copays $5-$20
• Prior authorization: Generally not required

For patients struggling with costs, direct them to our savings guide: how to save money on Bacitracin/Polymyxin B.

Tools and Resources for Providers

Several resources can help you and your patients navigate this shortage:

• Medfinder for Providers — Check real-time pharmacy availability and help patients locate medications in stock
• ASHP Drug Shortage Database — Monitor shortage status and estimated resupply dates
• FDA Drug Shortages page — Official updates from the FDA on manufacturer supply

Consider adding a note to your EHR or prescribing workflow to flag Bacitracin/Polymyxin B as a shortage medication. This can prompt alternative selection at the point of prescribing and reduce patient frustration at the pharmacy.

For a step-by-step approach to helping patients find this medication, see our companion guide: how to help your patients find Bacitracin/Polymyxin B in stock.

Looking Ahead

Padagis has estimated a return to production by October 2026. If this timeline holds, we would expect pharmacy-level availability to normalize by late 2026 or early 2027. However, several factors could affect this:

• Manufacturing restart timelines are estimates and have shifted in the past
• Demand may surge once product returns, creating temporary spikes in ordering
• Other manufacturers may enter or expand in this space, improving long-term supply diversity

Providers should plan for continued limited availability through at least Q3 2026 and maintain familiarity with alternative agents.

Final Thoughts

The Bacitracin/Polymyxin B ophthalmic shortage is a manageable clinical challenge when approached proactively. By staying informed about the shortage status, having alternative therapies ready, and using tools like Medfinder for Providers to check real-time availability, you can minimize treatment delays and maintain quality care for your patients.

We'll continue to update this article as new supply information becomes available.