Is applying topical mupirocin (antibiotic ointment) with each dressing change and covering with a silicone foam dressing, with dressing changes performed twice a week, an effective approach to wound care?

Topical Mupirocin with Silicone Foam Dressing for Wound Care

Topical mupirocin should not be used with silicone foam dressings for routine wound care, as there is no evidence supporting this practice for wound healing, and current guidelines specifically recommend against using topical antimicrobial dressings for wound healing. 1

Evidence Against Topical Antimicrobial Dressings

The 2023 International Working Group on the Diabetic Foot (IWGDF) guidelines provide a strong recommendation against using topical antiseptic or antimicrobial dressings for wound healing:

• "Do not use topical antiseptic or antimicrobial dressings for wound healing of diabetes-related foot ulcers" (Strong recommendation; Moderate evidence) 1
• Multiple studies evaluating antimicrobial dressings showed no significant improvement in complete healing or percentage area wound reduction 1

Appropriate Wound Care Approaches

Recommended Dressing Practices

• Cover clean superficial wounds with an occlusive dressing to promote wound healing (reasonable recommendation) 1
• For diabetic foot ulcers that have not improved with standard care for at least 2 weeks, consider sucrose-octasulfate impregnated dressings as an adjunctive treatment (Conditional recommendation) 1
• Use atraumatic and absorptive dressings such as foam dressings without antimicrobial agents

Dressing Change Frequency

• Changing dressings twice weekly as proposed is reasonable for many wounds
• However, dressing change frequency should be determined by:
  • Amount of exudate
  • Type of wound
  • Signs of infection
  • Manufacturer's recommendations for the specific dressing used

Risks of Inappropriate Mupirocin Use

Mupirocin is a topical antibiotic with excellent activity against staphylococci and streptococci 2, 3, but:

1. It should be reserved for specific indications such as:

   • Treatment of impetigo 4, 5
   • Eradication of nasal MRSA carriage 3
   • Specific superficial skin infections with confirmed susceptible pathogens

2. Inappropriate use risks:

   • Development of antimicrobial resistance
   • Potential local reactions including pruritus, burning, and erythema 4
   • Diversion from evidence-based wound care practices

Signs to Monitor and When to Seek Medical Care

If a person with a superficial wound develops any of the following, remove the dressing, inspect the wound, and obtain medical care 1:

• Redness extending beyond wound edges
• Swelling
• Foul-smelling wound drainage
• Increased pain
• Fever

Alternative Evidence-Based Approaches

For wound care, consider these evidence-based alternatives:

• Standard wound care practices including sharp debridement of non-viable tissue 1
• Maintaining a moist wound environment with appropriate non-antimicrobial dressings 1
• Negative Pressure Wound Therapy (NPWT) after complete removal of necrosis for appropriate wounds 1
• For infected wounds, systemic antibiotics rather than topical antimicrobials when clinically indicated 1

Conclusion

The practice of applying mupirocin with each dressing change and covering with a silicone foam dressing is not supported by current evidence and guidelines. Instead, focus on evidence-based wound care practices including appropriate non-antimicrobial dressings, proper wound bed preparation, and systemic antibiotics only when clinically indicated for infection.