How to treat a nostril infection with mupirocin?

Treatment of Nostril Infection with Mupirocin

Mupirocin should be applied to the infected nostril twice daily for 5-10 days to effectively treat the infection and eradicate Staphylococcus aureus carriage. 1, 2

Diagnosis and Documentation

• Document the following in the patient chart:
  • Location and extent of infection (anterior nares, vestibule)
  • Presence of erythema, swelling, tenderness, or purulent drainage
  • Any systemic symptoms (fever, malaise)
  • Risk factors (prior history of MRSA, healthcare exposure)
  • Duration of symptoms

Treatment Protocol

Primary Treatment

1. Mupirocin 2% ointment application:

   • Apply a small amount (pea-sized) to the affected nostril twice daily for 5-10 days 1, 2
   • Use a cotton swab or clean fingertip to apply the ointment
   • Gently massage the outside of the nose after application to distribute the medication

2. Application technique:

   • Wash hands thoroughly before and after application
   • Insert the ointment just inside the nostril (anterior nares)
   • Avoid deep insertion into nasal passages 2

Monitoring and Follow-up

• Evaluate clinical response within 3-5 days of initiating treatment 2
• If no improvement is seen within this timeframe, reassess diagnosis and consider alternative treatments
• Document treatment response in patient chart

Patient Education

Provide the following instructions to the patient:

1. Complete the full course of treatment even if symptoms improve quickly
2. Apply medication exactly as prescribed (twice daily for full duration)
3. Wash hands thoroughly before and after application
4. Avoid sharing personal items like towels, razors, or nasal spray bottles 1
5. Report any worsening symptoms, severe irritation, or lack of improvement after 3-5 days

Prevention of Recurrence

For patients with recurrent staphylococcal infections:

1. Consider decolonization strategy:

   • Nasal mupirocin twice daily for 5-10 days 1
   • Consider adding chlorhexidine body washes for comprehensive decolonization 1

2. Environmental measures:

   • Clean high-touch surfaces regularly
   • Wash bedding and towels in hot water
   • Avoid sharing personal items 1

Special Considerations

• Cautions:

  • Avoid use on mucosal surfaces other than nasal passages 2
  • Discontinue if chemical irritation or sensitivity reaction occurs 2
  • Not recommended for long-term continuous use due to potential for bacterial resistance

• Documentation requirements:

  • Initial presentation and symptoms
  • Treatment plan with specific medication, dose, and duration
  • Patient education provided
  • Follow-up plan and criteria for reassessment

Evidence Summary

Mupirocin is highly effective against Staphylococcus aureus, the most common pathogen in nostril infections 3. Research demonstrates that nasal application of mupirocin significantly reduces S. aureus colonization and subsequent infections 4, 5. A randomized controlled trial showed that monthly application of mupirocin in staphylococcal carriers reduced both nasal colonization and skin infections 4.

The Infectious Diseases Society of America guidelines specifically recommend nasal decolonization with mupirocin twice daily for 5-10 days for treatment of recurrent staphylococcal infections 1. This approach has been shown to be effective in eradicating nasal carriage of S. aureus and preventing subsequent infections 5, 6.