What is the recommended treatment for impetigo using mupirocin (Bactroban)?

From the Guidelines

Mupirocin (Bactroban) is the recommended topical antibiotic for treating impetigo, with a recommended application of a thin layer to the affected areas twice daily for 5 days. This recommendation is based on the guidelines for the diagnosis and management of skin and soft tissue infections by the Infectious Diseases Society of America 1. The guidelines suggest that treatment of bullous and nonbullous impetigo should be with either topical mupirocin or retapamulin twice daily for 5 days, with a strong, high-quality evidence recommendation.

Some key points to consider when using mupirocin for impetigo include:

• Applying a thin layer of mupirocin 2% ointment to the affected areas twice daily for 5 days
• Gently washing the affected areas with warm water and mild soap before application, then patting dry
• Continuing treatment for the full prescribed duration, even if symptoms improve earlier, to ensure complete eradication of the infection
• Mupirocin works by inhibiting bacterial protein synthesis, effectively targeting Staphylococcus aureus and Streptococcus pyogenes, the primary causative organisms of impetigo
• For extensive or severe infections, oral antibiotics may be needed in addition to topical treatment
• Keeping the affected areas clean and avoiding scratching to prevent spreading the infection to other body parts or individuals
• Consulting a healthcare provider if symptoms worsen or don't improve after 3-5 days of treatment, as a different antibiotic approach may be necessary.

It's also important to note that the guidelines recommend oral therapy for patients with numerous lesions or in outbreaks affecting several people to help decrease transmission of infection 1. However, for patients with a limited number of lesions, topical mupirocin or retapamulin is recommended 1.

From the FDA Drug Label

INDICATIONS AND USAGE Centany (mupirocin ointment),2% is indicated for the topical treatment of impetigo due to: Staphylococcus aureus and Streptococcus pyogenes. CLINICAL STUDIES The efficacy of topical Centany (mupirocin ointment),2% in impetigo was tested in one study. Patients with impetigo were randomized to receive either Centany (mupirocin ointment), 2% or Bactroban® Ointment (mupirocin ointment, 2%) t.i.d. for 7 days.

The recommended treatment for impetigo using mupirocin (Bactroban) is topical application of mupirocin ointment, 2% three times a day for 7 days.

• Clinical efficacy rates: 94% for Centany (mupirocin ointment), 2% and 95% for Bactroban® Ointment (mupirocin ointment, 2%) 2 2
• Pathogen eradication rates: 98% for both medications 2

From the Research

Treatment of Impetigo with Mupirocin

Mupirocin, also known as Bactroban, is a topical antibiotic used to treat impetigo, a highly contagious superficial skin infection. The following points summarize the recommended treatment for impetigo using mupirocin:

• Mupirocin (2 percent) ointment is effective against gram-positive staphylococci and streptococci, which are the predominant pathogens in most superficial skin infections 3.
• Topical mupirocin has been shown to be as effective as oral therapy in many cases of impetigo, with fewer adverse effects and less likelihood of inducing antibiotic resistance 4.
• Clinical improvement with mupirocin should be seen in 85% to 100% of patients within 3 to 5 days of application three times daily 5.
• Topical mupirocin is superior to oral erythromycin, with a pooled odds ratio of 1.22 (95% CI 1.05 to 2.97) 6.
• Mupirocin and fusidic acid are equally effective, with no significant difference in cure rates (pooled OR 1.76,95% CI 0.69 to 2.16) 6.

Advantages of Mupirocin

The use of mupirocin for impetigo treatment has several advantages, including:

• Low incidence of adverse effects 5.
• Less expensive and easier to administer than oral antibiotics 3.
• Less likely to induce antibiotic resistance 3.
• Effective against a range of pathogens, including gram-positive staphylococci and streptococci 3.

Comparison with Other Treatments

Mupirocin has been compared to other treatments for impetigo, including:

• Oral antibiotics: topical mupirocin is superior to oral erythromycin, but there is no significant difference in cure rates between topical and oral antibiotics in most cases 6.
• Fusidic acid: mupirocin and fusidic acid are equally effective, with no significant difference in cure rates 6.
• Penicillin: penicillin is inferior to erythromycin and cloxacillin, and there is little evidence that using disinfectant solutions improves impetigo 6.