From the Guidelines
Mupirocin (Bactroban) is recommended for treating localized bacterial skin infections and eradicating MRSA colonization, particularly in the nasal passages. For skin infections, apply a small amount of 2% mupirocin ointment to the affected area three times daily for 7-10 days. For MRSA nasal decolonization, apply a pea-sized amount of 2% mupirocin ointment inside each nostril twice daily for 5-7 days. When treating impetigo or small skin infections, clean the area gently before application and consider covering with a sterile bandage. For comprehensive MRSA decolonization protocols, mupirocin nasal application is often combined with chlorhexidine body washes and sometimes oral antibiotics depending on infection severity. Mupirocin works by inhibiting bacterial protein synthesis by binding to bacterial isoleucyl-tRNA synthetase, making it effective against many gram-positive bacteria including MRSA. To prevent resistance development, mupirocin should not be used for more than 10 consecutive days or repeatedly without clear indication. Side effects are typically mild and may include local burning, stinging, or irritation at the application site.
Some key points to consider when using mupirocin include:
- The use of topical mupirocin for localized and nonbullous impetigo, as stated in the study 1.
- The potential for low-level and high-level resistance to mupirocin in S. aureus, as noted in the study 1.
- The importance of individualizing treatment duration based on the patient’s clinical response, as recommended in the study 1.
- The consideration of empirical therapy for MRSA in patients with severe or extensive disease, as suggested in the study 1.
- The use of mupirocin in combination with other treatments, such as chlorhexidine body washes and oral antibiotics, for comprehensive MRSA decolonization protocols.
It is essential to follow the recommended treatment protocols and guidelines to ensure effective treatment and prevent resistance development. The most recent and highest quality study, 1, provides guidance on the use of mupirocin for skin infections and MRSA decolonization, and its recommendations should be prioritized in clinical practice. By following these guidelines and using mupirocin as recommended, healthcare providers can effectively treat localized bacterial skin infections and eradicate MRSA colonization, improving patient outcomes and reducing the risk of resistance development.
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. Mupirocin ointment, 2% is indicated for the topical treatment of impetigo due to: Staphylococcus aureus and Streptococcus pyogenes.
The recommended use and treatment protocol for Mupirocin is to apply a small amount of ointment to the affected area three times daily. The treatment is indicated for impetigo due to Staphylococcus aureus and Streptococcus pyogenes. However, there is no direct information in the provided drug labels about the treatment protocol for MRSA (Methicillin-resistant Staphylococcus aureus) eradication. 2 2
From the Research
Recommended Use of Mupirocin
- Mupirocin is a novel antibiotic used for topical treatment of bacterial skin infections, including those caused by Staphylococcus aureus and Streptococcus pyogenes 3, 4, 5.
- It is effective against a wide range of Gram-positive bacteria and moderately active against Gram-negative bacteria 3, 4.
- Mupirocin 2% ointment is applied 2 or 3 times daily and has demonstrated efficacy in treating primary and secondary skin infections, including impetigo and infected wounds 3, 4, 5.
Treatment Protocol for Bacterial Skin Infections
- For uncomplicated skin and skin structure infections (uSSSIs), mupirocin ointment can be used topically, while oral antibiotics such as dicloxacillin, cephalexin, and clindamycin may also be recommended 6.
- Topical mupirocin has been shown to be effective in treating impetigo, with cure rates superior to placebo and comparable to other topical antibiotics such as fusidic acid 7.
- The choice of treatment may depend on the severity of the infection, the presence of methicillin-resistant Staphylococcus aureus (MRSA), and local susceptibility patterns 6.
Eradication of MRSA
- Mupirocin has been shown to be effective in eradicating nasal carriage of Staphylococcus aureus, including MRSA, with elimination rates of over 95% in bacteriologically controlled studies 3.
- Intranasal 2% calcium mupirocin has been used to eradicate nasal carriage of MRSA, and its role in preventing staphylococcal infection is currently being evaluated 3.