From the Guidelines
Mupirocin is typically prescribed for 5-10 days for the treatment of bacterial skin infections, including MRSA colonization in the nares, as recommended by the Infectious Diseases Society of America 1. The medication is applied topically to the affected area 2-3 times daily, with a thin layer covering the infection site and potentially a small margin of surrounding skin.
- For specific conditions like impetigo or folliculitis, treatment may sometimes be extended to 12 days.
- It's essential to complete the full prescribed course even if symptoms improve earlier to ensure complete eradication of the infection and prevent antibiotic resistance. Mupirocin works by inhibiting bacterial protein synthesis, specifically by binding to bacterial isoleucyl-tRNA synthetase, which prevents the incorporation of isoleucine into bacterial proteins 1. This mechanism makes it effective against many gram-positive bacteria, including Staphylococcus aureus (including MRSA) and Streptococcus species, which are common causes of skin infections.
- The use of mupirocin alone or in combination with topical antiseptics, such as chlorhexidine and diluted bleach baths, may be considered for decolonization in patients with recurrent MRSA skin and soft tissue infections (SSTI) 1. However, the optimal regimen, frequency of application, and duration of therapy are unclear, and more research is needed to determine the effectiveness of these strategies.
From the FDA Drug Label
A small amount of mupirocin ointment should be applied to the affected area three times daily. The area treated may be covered with a gauze dressing if desired. Patients not showing a clinical response within 3 to 5 days should be re-evaluated. The efficacy of topical mupirocin ointment in impetigo was tested in two studies. In the first, patients with impetigo were randomized to receive either mupirocin ointment or vehicle placebo t.i. d. for 8 to 12 days. In the second study, patients with impetigo were randomized to receive either mupirocin ointment t.i. d. or 30 to 40 mg/kg oral erythromycin ethylsuccinate per day (this was an unblinded study) for 8 days.
The typical treatment duration for bacterial skin infections with mupirocin (Bactroban) is 8 to 12 days 2 or 8 days 2.
- The treatment should be re-evaluated if there is no clinical response within 3 to 5 days.
- Key points:
- Apply a small amount of mupirocin ointment to the affected area three times daily.
- Cover the area with a gauze dressing if desired.
From the Research
Mupirocin Treatment Duration
- The typical treatment duration for bacterial skin infections with mupirocin (Bactroban) is usually around 5 to 9 days 3, 4.
- A study published in 2009 recommended applying mupirocin to the anterior nares 2-3 times/day for 5 days for MRSA decolonization 3.
- Another study from 1989 evaluated the efficacy and safety of 2% mupirocin ointment in the treatment of primary and secondary skin infections, with treatment consisting of application of the ointment three times daily for an average of nine days 4.
- The treatment duration may vary depending on the severity of the infection and the patient's response to treatment.
Factors Affecting Treatment Duration
- The emergence of drug resistance can affect the treatment duration and effectiveness of mupirocin 5, 6.
- Increased use of mupirocin has been associated with the emergence of resistance, which can reduce the effectiveness of decolonizing strategies for S. aureus or MRSA 6.
- The development of low-level resistance against mupirocin can lead to recolonization, making treatment duration longer or less effective 6.
Clinical Relevance
- Mupirocin is a topical antibiotic used for decolonization of MSSA and MRSA, as well as for treatment of local skin and soft tissue infections caused by S. aureus and streptococcal species 6.
- The clinical relevance of mupirocin resistance in Staphylococcus aureus highlights the need for prudent use of this antibiotic to prevent the emergence of resistance 6.