Treatment for MRSA Colonization
The recommended treatment for MRSA colonization is intranasal mupirocin 2% ointment applied twice daily for 5-10 days combined with topical antiseptic body decolonization using chlorhexidine washes or dilute bleach baths. 1, 2
Primary Decolonization Regimen
Nasal Decolonization
- Mupirocin 2% ointment applied to the anterior nares twice daily for 5-10 days 1, 2
- The 10-dose regimen (twice daily for 5 days) is superior to shorter regimens, with 89.5% of patients remaining decolonized for at least four weeks after therapy 3
Body Decolonization (choose one)
- Chlorhexidine gluconate 2-4% body washes daily for 5-14 days 1, 2
- Dilute bleach baths (1 teaspoon per gallon of bath water) for 15 minutes twice weekly for up to 3 months 1, 2
When to Consider Decolonization
Decolonization should be considered in the following situations:
- Patients with recurrent MRSA skin and soft tissue infections (SSTIs) 1, 2
- Prior to certain surgical procedures to reduce risk of surgical site infections
- During MRSA outbreaks in healthcare or community settings 4
- When ongoing MRSA transmission is occurring despite standard precautions 2
Efficacy and Monitoring
- Mupirocin nasal application combined with chlorhexidine bathing has shown 52% reduction in MRSA colonization and infection in ICU settings 4
- More comprehensive decolonization regimens including oral antibiotics have demonstrated 74% MRSA eradication at 3 months 5
- Monitor for recolonization, which may occur in approximately 10-30% of patients within 1-2 months after treatment 6
Important Considerations and Potential Pitfalls
Mupirocin Resistance
- Increased mupirocin use correlates with resistance development 7
- High-level mupirocin resistance is associated with treatment failure 2
- Baseline mupirocin resistance is a significant predictor of decolonization failure (RR 9.4) 5
- Routine susceptibility testing should be considered before repeated decolonization attempts
When to Consider Oral Antibiotics
Oral antibiotics for decolonization should only be considered when:
- Topical measures have failed despite good adherence
- Recurrent MRSA infections continue despite topical decolonization
- Multiple body sites are colonized 1
If oral antibiotics are necessary, options include:
- Rifampin-based combinations (with TMP-SMX or doxycycline)
- Short courses (5-10 days) to minimize resistance development 1
Additional Measures for Successful Decolonization
- Maintain good personal hygiene with regular bathing
- Clean hands regularly with soap and water or alcohol-based sanitizer
- Avoid sharing personal items (razors, towels, linens)
- Keep draining wounds covered with clean, dry bandages
- Clean high-touch surfaces with appropriate disinfectants 2
- Consider evaluating and treating household contacts if ongoing transmission occurs 2
Alternative Prevention Strategies for Recurrent Infections
For patients with recurrent MRSA infections despite initial decolonization:
- Monthly application of mupirocin (5-day course each month) may reduce recurrent infections by approximately 50% 2
- Daily chlorhexidine bathing in high-risk settings has shown benefit in preventing MRSA transmission 4
The combination of nasal mupirocin and antiseptic body decolonization remains the cornerstone of MRSA decolonization therapy, with oral antibiotics reserved for refractory cases or special circumstances.