From the Guidelines
The recommended protocol for decolonization of Methicillin-resistant Staphylococcus aureus (MRSA) in patients involves a 5-day decolonization regimen consisting of twice daily intranasal mupirocin, daily chlorhexidine washes, and daily decontamination of personal items such as towels, sheets, and clothes. This protocol is based on the most recent and highest quality study available, which suggests that this regimen may be effective in reducing MRSA colonization and preventing recurrent infections 1. The use of intranasal mupirocin and chlorhexidine washes targets the common colonization sites of MRSA, including the nasal passages and skin surfaces.
Some key points to consider when implementing this protocol include:
- The use of intranasal mupirocin 2% ointment applied to both nostrils twice daily for 5 days
- The use of chlorhexidine gluconate 4% body wash used daily for 5 days, focusing on the entire body from neck down with special attention to the axilla, groin, and perineum
- Daily changing of bed linens, towels, and clothing during the treatment period
- The importance of using all components of the protocol simultaneously for complete effectiveness
It is also important to note that the evidence for the effectiveness of this protocol is based on a study from 2014, and more recent studies may have been published since then 1. However, based on the available evidence, this protocol appears to be a reasonable approach to reducing MRSA colonization and preventing recurrent infections.
In terms of specific patient populations, this protocol may be particularly useful for patients with recurrent MRSA infections, or for patients who are at high risk of developing MRSA infections, such as those undergoing surgical procedures or with compromised immune systems. Additionally, this protocol may be useful in outbreak settings, such as in healthcare facilities or in communities with high rates of MRSA transmission.
Overall, the recommended protocol for decolonization of MRSA in patients involves a comprehensive approach that targets the common colonization sites of the bacteria and includes measures to prevent recurrent infections.
From the FDA Drug Label
Mupirocin is active against a wide range of gram-positive bacteria including methicillin-resistant Staphylococcus aureus (MRSA). The protocol for decolonization of MRSA in patients is not explicitly stated in the provided drug label.
- The label provides information on the antibacterial activity of mupirocin against MRSA.
- However, it does not provide a specific protocol for decolonization. 2
From the Research
Protocol for Decolonization of MRSA
The protocol for decolonization of Methicillin-resistant Staphylococcus aureus (MRSA) in patients involves a combination of topical and oral antimicrobial therapy.
- The treatment typically includes:
- 4% chlorhexidine soap for bathing and washing
- 2% mupirocin ointment applied to the anterior nares three times a day
- Rifampin (300 mg twice daily) and either trimethoprim/sulfamethoxazole (160 mg/800 mg twice daily) or doxycycline (100 mg twice daily) for seven days 3
- Alternatively, a six-month dual antibiotic regimen of rifampicin and fusidic acid, along with topical decolonization measures, has been shown to be effective in eradicating MRSA from respiratory tract samples 4
- Nasal decolonization using mupirocin remains the most effective topical agent, but concerns over resistance have led to the development of alternative agents such as nasal povidone-iodine and alcohol-based nasal antiseptic 5
Effectiveness of Decolonization
- Decolonization of patients has been shown to be the most effective intervention in controlling nosocomial spread of MRSA, outperforming patient isolation even with low decolonization efficacy 6
- Universal decolonization with mupirocin and chlorhexidine body washing has been found to be more cost-effective than targeted decolonization, with an equally low risk of mupirocin resistance in S. aureus 7
Considerations for Decolonization
- The choice of decolonization strategy depends on various factors, including the presence of indwelling medical devices, extranasal sites of colonization, and the risk of mupirocin resistance 3, 5
- Regular screening of healthcare workers followed by decolonization of MRSA-carriers may not be effective in reducing nosocomial spread of MRSA unless there are few persistently colonized healthcare workers responsible for a large fraction of the acquisitions 6