What is the recommended treatment for bacterial skin infections using Bactroban (mupirocin)?

Recommended Treatment for Bacterial Skin Infections Using Mupirocin (Bactroban)

Topical mupirocin (Bactroban) is recommended for localized and nonbullous impetigo, applied to the affected area three times daily for 5-7 days. 1, 2

Primary Indications for Mupirocin

• Impetigo (first-line therapy): Apply a small amount to affected area three times daily for 5 days 1, 2
• Localized MRSA skin infections: Particularly effective for small, superficial infections 1
• Nasal decolonization: For recurrent skin infections or MRSA carriers, apply intranasally twice daily for 5-10 days 1

Clinical Efficacy

Mupirocin demonstrates excellent efficacy in treating superficial skin infections:

• Clinical cure or improvement in >90% of patients with primary skin infections 3, 4
• Pathogen eradication rates of >90% for susceptible organisms 3
• Comparable or superior efficacy to oral antibiotics for impetigo 5

Treatment Algorithm for Bacterial Skin Infections

1. Assess the Infection Type and Severity

• Nonbullous/localized impetigo: Use topical mupirocin as first-line therapy 1
• Bullous impetigo with few lesions: Topical mupirocin is appropriate 1
• Extensive impetigo or multiple lesions: Consider oral antibiotics instead 1
• Presence of abscess: Incision and drainage is primary treatment; mupirocin may be used as adjunctive therapy 1

2. Application Instructions

• Apply a small amount of mupirocin ointment to the affected area three times daily 2
• The area may be covered with a gauze dressing if desired 2
• Continue treatment for 5 days for impetigo 1
• Re-evaluate patients not showing clinical response within 3-5 days 2

3. Special Considerations

• MRSA infections: Mupirocin is effective against many MRSA strains 1
• Recurrent infections: Consider nasal decolonization with mupirocin twice daily for 5-10 days 1
• Outbreak situations: Oral antibiotics may be preferred to decrease transmission 1

Decolonization Protocol for Recurrent Infections

For patients with recurrent skin infections despite optimizing wound care and hygiene:

1. Nasal mupirocin twice daily for 5-10 days 1
2. Consider combining with chlorhexidine body washes or dilute bleach baths 1
3. Implement environmental hygiene measures focusing on high-touch surfaces 1

Limitations and Resistance Concerns

• High-level resistance to mupirocin has been associated with decolonization failure 1
• Mupirocin should not be used for extended periods to avoid developing resistance 1, 6
• Not appropriate as monotherapy for deep or complicated infections 1

When to Use Alternative Treatments

• Extensive or systemic infections: Use oral antibiotics such as dicloxacillin, cephalexin, clindamycin, or SMX-TMP 1
• Treatment failure: If no improvement after 3-5 days, consider culture and sensitivity testing and switch to alternative therapy 2
• Deep tissue involvement: Oral or IV antibiotics are required 1

Monitoring and Follow-up

• Evaluate clinical response within 3-5 days of starting treatment 2
• Complete resolution of impetigo typically occurs within 7 days with appropriate therapy
• For recurrent infections, consider evaluation of household contacts and implementation of decolonization strategies 1

Mupirocin remains one of the most effective topical antibiotics for localized bacterial skin infections, particularly impetigo, with excellent safety profile and minimal side effects when used appropriately for short-term treatment.