Is there treatment for Methicillin-resistant Staphylococcus aureus (MRSA) colonization in the nasal cavity (nares)?

From the Guidelines

Yes, there is treatment for MRSA (Methicillin-resistant Staphylococcus aureus) colonization in the nares (nostrils), and the standard treatment is mupirocin (Bactroban) nasal ointment, which is applied inside each nostril twice daily for 5-10 days, as recommended by the Infectious Diseases Society of America 1.

Treatment Overview

The treatment for MRSA nares colonization typically involves decolonization strategies, which may include:

• Nasal decolonization with mupirocin twice daily for 5-10 days
• Topical body decolonization regimens with a skin antiseptic solution, such as chlorhexidine, for 5-14 days
• Dilute bleach baths, with 1 teaspoon of bleach per gallon of water, given for 15 minutes twice weekly for 3 months 1

Importance of Treatment

Treatment is important because nasal colonization serves as a reservoir for MRSA that can lead to recurrent infections or spread to others. Decolonization therapy is particularly recommended for patients with recurrent MRSA infections, before certain surgeries, or in healthcare workers to prevent transmission in healthcare settings.

Success Rates

Success rates for decolonization are approximately 80-90% initially, though recolonization can occur over time 1.

Key Considerations

When considering decolonization therapy, it is essential to weigh the potential benefits against the risks of selecting for more-resistant or more-virulent strains. Additionally, the optimal regimen, frequency of application, and duration of therapy are unclear, and more research is needed to determine the most effective approach 1.

From the FDA Drug Label

Mupirocin is active against a wide range of gram-positive bacteria including methicillin-resistant Staphylococcus aureus (MRSA). Mupirocin has been shown to be active against most strains of Staphylococcus aureus and Streptococcus pyogenes, both in vitro and in clinical studies.

Treatment for MRSA in the nares is available, and mupirocin is an option. The drug label indicates that mupirocin is active against MRSA, suggesting its potential use in treating MRSA infections in the nares 2.

From the Research

Treatment for MRSA Nares

• There are several treatment options available for MRSA nares, including:
  • Povidone-iodine solution, which has been shown to be effective in reducing the bioburden of MRSA in the anterior nares 3, 4
  • Mupirocin ointment, which is commonly used for decolonization of MRSA from the nasal cavity 5
  • Other antibiotics, such as clindamycin, daptomycin, and vancomycin, which may be used to treat MRSA infections 6

Efficacy of Treatment Options

• Povidone-iodine solution has been shown to be effective in reducing MRSA colonization in the nasal cavity, with a significant reduction in bacterial load compared to saline 3
• Mupirocin ointment has been shown to be effective in decolonizing MRSA from the nasal cavity, but may have a higher risk of resistance development 5
• The efficacy of treatment options may vary depending on individual factors, such as age, gender, and underlying health conditions 5

Diagnosis and Prediction of MRSA Nares

• MRSA nares swab is a useful tool for predicting MRSA wound infection, with a high positive predictive value and positive likelihood ratio 7
• Clinical risk factors, such as previous MRSA infection or colonization, may also be used to predict MRSA nares, but may not be as accurate as MRSA nares swab 7