What amount of mupirocin (Bactroban) ointment should be dispensed for a 7-day treatment course?

Mupirocin Dispensing for 7-Day Treatment Course

For a 7-day treatment course of mupirocin (Bactroban) ointment, 15 grams should be dispensed when treating impetigo or other localized skin infections.

Dosing and Application Guidelines

Mupirocin ointment is typically prescribed as follows:

• Concentration: 2% ointment in a polyethylene glycol base 1
• Application frequency: Apply twice daily for 7 days 2
• Standard packaging: Available in 15g and 30g tubes

Evidence Supporting This Recommendation

According to the Infectious Diseases Society of America (IDSA) guidelines for skin and soft tissue infections, mupirocin ointment should be applied to lesions twice daily for patients with a limited number of impetigo lesions 3. The recommended duration of treatment is typically 5-7 days, with 7 days being the standard course for complete eradication of the causative organisms.

The IDSA guidelines specifically state:

• "Mupirocin ointment [should be] applied to lesions twice daily" for patients with impetigo with a limited number of lesions 3
• For localized, uncomplicated impetigo, topical mupirocin 2% ointment applied twice daily for 5-7 days is recommended 2

Clinical Efficacy Considerations

When dispensing mupirocin, consider these important clinical factors:

• Clinical improvement should be seen within 3-5 days of starting treatment 4
• Bacteriological cure rates with mupirocin are approximately 97% for susceptible organisms 5
• The full 7-day course should be completed even if the infection appears to resolve earlier 2

Practical Dispensing Considerations

For a 7-day course with twice-daily application:

• A small amount (pea-sized) is typically sufficient for each application to a localized area
• 15g tube is adequate for treating limited lesions for 7 days
• For more extensive involvement or multiple lesions, a 30g tube may be necessary

Important Clinical Pearls

1. Avoid underdispensing: Insufficient quantity may lead to premature discontinuation and treatment failure

2. Patient education: Instruct patients to:

   • Apply a thin layer to affected areas twice daily
   • Complete the full 7-day course even if improvement is seen earlier
   • Wash hands before and after application to prevent spread

3. Monitoring: Improvement should be seen within 3-5 days; if not, reevaluation is warranted 4

4. Alternative considerations: For extensive impetigo or multiple lesions, systemic antibiotics may be more appropriate than topical therapy 2

Conclusion

For a standard 7-day treatment course of mupirocin for localized impetigo or other superficial skin infections, dispensing a 15g tube is appropriate and aligns with clinical guidelines and evidence-based practice.