From the Guidelines
Mupirocin is the primary topical antibiotic recommended for treating localized MRSA skin infections, applied as a 2% ointment to the affected area three times daily for 5-10 days. This recommendation is based on the most recent and highest quality study available, which suggests that mupirocin is effective in treating minor skin infections, such as impetigo, and secondarily infected skin lesions, including those caused by MRSA 1.
Key Points to Consider
- Mupirocin is typically applied as a 2% ointment (brand name Bactroban) to the affected area three times daily for 5-10 days.
- For nasal decolonization, mupirocin is applied inside each nostril twice daily for 5 days.
- Retapamulin (Altabax) is an alternative option for skin infections, applied twice daily for 5 days.
- Topical antibiotics work by disrupting bacterial protein synthesis, preventing MRSA from reproducing.
- It's essential to complete the full course of treatment even if symptoms improve quickly and combine antibiotic treatment with proper wound care, including regular cleaning and covering the infected area to prevent spread to others.
Important Considerations for Treatment
- The use of topical antibiotics, such as mupirocin, should be guided by knowledge of local patterns of susceptibility of S. aureus, especially local rates of MRSA 1.
- For more extensive MRSA infections, topical treatment alone is usually insufficient, and oral antibiotics like trimethoprim-sulfamethoxazole, doxycycline, or linezolid may be necessary 1.
- The choice of antibiotic should be based on the severity of the infection, the presence of systemic illness, and the patient's underlying health status 1.
References to Support Recommendations
The recommendations provided are supported by studies published in reputable journals, including Pediatrics 1 and Clinical Infectious Diseases 1, which emphasize the importance of proper antibiotic use and wound care in the treatment of MRSA infections.
From the Research
Topical Antibiotics for MRSA
- Mupirocin is a topical antibiotic that has been shown to be effective in treating MRSA infections, particularly in burn wounds 2, 3.
- Studies have demonstrated that mupirocin can eliminate MRSA in burn wounds, with a maximum therapeutic response seen within 4 days 2.
- Mupirocin has been recommended for use on a selective basis, when current prophylactic topical therapy has failed to control MRSA infection in burns of less than 20% of the total body surface area, and for a limited period of 5 days 2.
- However, the emergence of mupirocin resistance, both high- and low-level, has been reported, which can reduce the effectiveness of decolonizing strategies for S. aureus or MRSA 4, 5.
- Retapamulin is another topical antibiotic that has been approved for the treatment of uncomplicated superficial skin infections caused by Staphylococcus aureus (excluding MRSA) and Streptococcus pyogenes, but its efficacy against MRSA is reduced 6.