From the Guidelines
Mupirocin (Bactroban) is the preferred topical antibiotic for treating generalized road rash compared to bacitracin. According to the most recent and highest quality study, apply a thin layer of mupirocin 2% ointment to the affected areas three times daily for 5-10 days after thoroughly cleaning the wounds with mild soap and water 1. Mupirocin is more effective against the common bacteria that typically infect road rash injuries, particularly Staphylococcus aureus (including MRSA) and Streptococcus species. It works by inhibiting bacterial protein synthesis, has a longer duration of action than bacitracin, and generally causes fewer allergic reactions.
Before applying the antibiotic, ensure the wound is properly cleaned and debris is removed to prevent infection and tattoo-like scarring. Cover larger areas with non-stick sterile dressings to protect the wound while healing. If signs of worsening infection develop (increasing redness, warmth, swelling, pus, or fever), seek medical attention as oral antibiotics may be necessary. The Infectious Diseases Society of America recommends mupirocin as the best topical agent for impetigo, which can be a complication of road rash, due to its effectiveness against S. aureus and S. pyogenes 1.
Key considerations for treatment include:
- Proper wound cleaning and debris removal
- Application of mupirocin 2% ointment three times daily
- Use of non-stick sterile dressings to protect the wound
- Monitoring for signs of worsening infection
- Seeking medical attention if oral antibiotics are necessary. The guidelines emphasize the importance of clinical assessment and appropriate treatment to prevent complications and promote healing 1.
From the Research
Comparison of Mupirocin and Bacitracin for Generalized Road Rash
- Mupirocin has been shown to be effective in treating primary and secondary skin infections, including those caused by Staphylococci and beta-haemolytic streptococci 2, 3.
- Bacitracin, on the other hand, has a narrower antibacterial spectrum and may produce treatment failure and sensitization when used topically 4.
- A study comparing the efficacy of mupirocin cream with other topical and oral agents found that mupirocin cream was significantly more effective than neomycin-bacitracin cream in reducing bacterial numbers in a mouse surgical wound model 5.
- Mupirocin cream has also been shown to be as effective as oral cephalexin in the treatment of secondarily infected wounds, with a clinical success rate of 95.1% compared to 95.3% for cephalexin 6.
- The use of mupirocin for generalized road rash may be preferred due to its broader antibacterial spectrum and lower risk of resistance and sensitization compared to bacitracin 4, 5.
- However, it is essential to note that the choice of topical antibiotic should be based on the specific causative pathogens and the severity of the infection, as well as the patient's medical history and potential allergies.
Key Findings
- Mupirocin has a broader antibacterial spectrum than bacitracin 2, 3.
- Mupirocin cream is as effective as oral cephalexin in treating secondarily infected wounds 6.
- Bacitracin may produce treatment failure and sensitization when used topically 4.
- Mupirocin cream is significantly more effective than neomycin-bacitracin cream in reducing bacterial numbers in a mouse surgical wound model 5.