Treatment of MRSA in Nasal Passages
Intranasal mupirocin 2% ointment applied twice daily for 5 days is the most effective treatment for eradicating MRSA colonization in nasal passages. 1
First-line Treatment
- Mupirocin 2% ointment should be applied to the anterior nares twice daily for 5 days as the primary treatment for nasal MRSA colonization 1, 2
- Mupirocin has excellent activity against Staphylococcus aureus (including MRSA) and Streptococcus species, making it the agent of choice for nasal decolonization 3, 2
- Complete the full 5-day course even if symptoms improve quickly to ensure complete eradication 1
Application Technique
- Wash hands thoroughly before and after application to prevent spread of infection 1
- Apply a small amount of ointment (about the size of a match head) to the inside of each nostril 1
- Close the nostrils by pressing the sides of the nose together and gently massage to spread the ointment throughout the nasal passage 2
- For a complete treatment course (10 total applications over 5 days), approximately 15 grams of ointment is typically needed 1
Addressing Recurrent Infections
- For recurrent MRSA nasal colonization, consider a decolonization protocol that includes: 4, 1
- Twice-daily intranasal mupirocin for 5 days
- Daily chlorhexidine washes
- Daily decontamination of personal items such as towels, sheets, and clothes
Monitoring and Follow-up
- Treatment should be extended if the infection has not improved within the initial 5-day period 4, 1
- For persistent or recurrent infections, cultures should be obtained to confirm continued MRSA presence and susceptibility 4
- Consider evaluation for underlying conditions that may predispose to recurrent colonization 4
Alternative Approaches
- For mupirocin-resistant MRSA (which occurs in approximately 1.43-3.57% of cases), alternative treatments may be necessary 5
- Bacteriophages (viruses targeting bacteria) have been proposed as a potential future treatment for multidrug-resistant S. aureus in nasal passages, though clinical studies in humans are still lacking 4
Important Considerations
- Nasal MRSA colonization rates have been increasing significantly in recent years, with studies showing rates as high as 9.2% in some populations 6
- Healthcare workers and those with hospital exposure have higher rates of nasal S. aureus colonization 5, 7
- Regular use of hand hygiene with hydro-alcoholic solutions has been shown to have a protective effect against nasal S. aureus carriage (OR = 0.36; 95% CI: 0.15-0.85) 7
Potential Pitfalls
- Premature discontinuation of treatment before completing the full 5-day course may lead to treatment failure 1
- Failure to address underlying causes of recurrent infections 4, 1
- Not considering mupirocin resistance in cases of treatment failure 5
By following this treatment approach, MRSA nasal colonization can be effectively managed, reducing the risk of subsequent infections and transmission to others.