What is the best treatment for an intranasal furuncle, Bactroban (mupirocin) topical vs oral antibiotics (abx)?

From the Guidelines

For an intranasal furuncle, topical mupirocin (Bactroban) is typically the first-line treatment for small, uncomplicated lesions, as it is effective against Staphylococcus aureus, a common cause of such infections 1. Apply mupirocin 2% ointment inside the nose three times daily for 7-10 days. However, oral antibiotics are recommended for larger furuncles, those with surrounding cellulitis, or when there are systemic symptoms. In these cases, an oral antibiotic with Staphylococcus aureus coverage such as cephalexin (500 mg four times daily) or dicloxacillin (500 mg four times daily) for 7-10 days is appropriate, as suggested by the guidelines for the diagnosis and management of skin and soft-tissue infections 1. If MRSA is suspected, consider clindamycin (300-450 mg three times daily) or trimethoprim-sulfamethoxazole (1-2 DS tablets twice daily), as these antibiotics have been shown to be effective against MRSA 1. Warm compresses applied to the area for 15-20 minutes several times daily can help promote drainage. Patients should avoid squeezing the furuncle to prevent spreading infection. Oral antibiotics are necessary when the infection extends beyond the nasal vestibule due to the risk of cavernous sinus thrombosis, a rare but serious complication of infections in this area due to the venous drainage system connecting to intracranial structures. It's also important to consider the potential for recurrent abscesses and the need for decolonization regimens, such as intranasal mupirocin and daily chlorhexidine washes, as outlined in the 2014 update by the Infectious Diseases Society of America 1.

Some key points to consider in the treatment of intranasal furuncles include:

• The use of topical mupirocin as first-line treatment for small, uncomplicated lesions
• The need for oral antibiotics in larger or more complicated cases
• The importance of considering MRSA in the treatment plan
• The use of warm compresses to promote drainage
• The need to avoid squeezing the furuncle to prevent spreading infection
• The potential for recurrent abscesses and the need for decolonization regimens.

Overall, the treatment of intranasal furuncles requires careful consideration of the size and complexity of the lesion, as well as the potential for complications and recurrent infections. By following the guidelines outlined above and considering the latest evidence from studies such as those published in 2014 1, healthcare providers can provide effective treatment and minimize the risk of complications.

From the FDA Drug Label

CLINICAL STUDIES The efficacy of topical mupirocin ointment in impetigo was tested in two studies. 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 FDA drug label does not answer the question.

From the Research

Treatment Options for Intranasal Furuncle

• Bactroban (mupirocin) topical and oral antibiotics (abx) are two treatment options for intranasal furuncle, but the best approach is not clearly established.
• Studies have shown that mupirocin nasal ointment can reduce the rate of nasal carriage and prevent postoperative S. aureus infections 2, 3.
• A randomized, double-blind, placebo-controlled trial found that intranasal treatment with mupirocin reduced the rate of S. aureus infections at surgical sites and prevented other nosocomial infections 2.
• A Cochrane review of nine RCTs involving 3396 participants found that intranasal mupirocin resulted in a statistically significant reduction in S. aureus infections 3.
• However, the use of mupirocin ointment may not be effective in all cases, and the development of resistance is a concern 4, 5.
• Alternative treatments, such as povidone-iodine preparation, have shown promise in reducing the bioburden of anterior nares prior to surgery 5.

Comparison of Topical and Oral Antibiotics

• There is limited evidence directly comparing the effectiveness of topical Bactroban (mupirocin) and oral antibiotics for the treatment of intranasal furuncle.
• However, studies suggest that topical mupirocin may be effective in reducing S. aureus nasal carriage and preventing postoperative infections 2, 3.
• Oral antibiotics may be necessary in more severe cases or when the infection is caused by a resistant strain of S. aureus.
• Further research is needed to determine the most effective treatment approach for intranasal furuncle, including the use of topical versus oral antibiotics 6, 4.