What is the best approach for decolonizing Methicillin-resistant Staphylococcus aureus (MRSA) from the elbow?

MRSA Decolonization Protocol for the Elbow

The most effective approach for decolonizing MRSA from the elbow involves a combination of mupirocin 2% ointment applied to the affected area twice daily for 5 days along with daily chlorhexidine gluconate body washes. 1

Comprehensive Decolonization Protocol

Topical Antimicrobial Treatment

• Apply mupirocin 2% ointment directly to the affected elbow area twice daily for 5 days 1
• Simultaneously apply mupirocin 2% ointment to the anterior nares twice daily for 5-10 days, as the nose is a common reservoir for MRSA 1, 2
• Complete the full course of mupirocin treatment, as the 10-dose regimen (5 days) is superior to shorter regimens for maintaining decolonization 3

Antiseptic Body Washing

• Use chlorhexidine gluconate 4% soap (40 mg/mL) for daily full-body washing during the 5-day treatment period 1
• Pay special attention to the elbow area, ensuring thorough cleansing 4
• Continue chlorhexidine washes for 5-14 days for optimal results 2, 5

Environmental and Hygiene Measures

• Keep the affected elbow covered with clean, dry bandages until decolonization is complete 1
• Avoid sharing personal items (towels, clothing, bedding) that may contact the elbow 1, 2
• Clean high-touch surfaces in the home environment with standard cleaning products 2
• Wash hands frequently, particularly after touching the affected area 1, 2

Additional Considerations

For Persistent or Recurrent MRSA Colonization

• If initial decolonization fails, consider extending the decolonization protocol with additional cycles 4
• For difficult-to-eradicate cases, systemic antibiotics may be considered as adjunctive therapy:
  • Rifampin plus doxycycline for 7 days has shown efficacy in combination with topical agents 5
  • Trimethoprim-sulfamethoxazole may be considered as an alternative 1

Monitoring and Follow-up

• Cultures from the elbow should be obtained 1-2 weeks after completing decolonization to confirm successful eradication 4
• For recurrent MRSA infections, consider evaluating household contacts for potential MRSA colonization 1, 2

Important Caveats and Pitfalls

• Mupirocin resistance can develop with repeated or prolonged use, so avoid repeated courses unless necessary 6, 7
• Decolonization may provide only temporary clearance, with recolonization occurring after discontinuation 2, 7
• Successful decolonization requires addressing all potential MRSA reservoirs, not just the elbow site 4
• The efficacy of decolonization therapy is reduced if the MRSA strain is mupirocin-resistant 5
• Systemic antibiotics should be reserved for cases where topical therapy has failed, to minimize antimicrobial resistance 1, 6

Special Populations

• For immunocompromised patients or those with prosthetic joints near the elbow, more aggressive and prolonged decolonization protocols may be warranted 1
• In patients scheduled for elective surgery involving the elbow, decolonization should be completed 1-2 weeks before the procedure 1