Treatment of Nasal MRSA Colonization (MARCONS)
Topical nasal mupirocin 2% ointment applied twice daily for 5 days is the recommended first-line treatment for nasal MRSA colonization. 1, 2
Treatment Protocol for Nasal MRSA Colonization
First-Line Treatment
- Apply mupirocin 2% ointment to both anterior nares twice daily for 5 days (10 total applications) 1, 2
- Complete the full 5-day course even if symptoms improve quickly to prevent treatment failure 1
- For a standard 5-day treatment course, approximately 15 grams of ointment is typically needed 1
Efficacy and Considerations
- Mupirocin has been shown to be significantly more effective than other topical agents like bacitracin for eradicating S. aureus nasal colonization (94% vs 44% efficacy) 3
- The standard 10-dose regimen (twice daily for 5 days) is superior to shorter regimens for maintaining decolonization for at least four weeks after therapy 4
- High-level resistance to mupirocin has been associated with subsequent failure of decolonization 5
Expanded Treatment for Recurrent MRSA Infections
For Patients with Recurrent MRSA Skin Infections
- Consider monthly application of mupirocin nasal ointment (5-day course each month) for persistent carriers with recurrent skin infections 6
- Monthly application has been shown to significantly reduce both nasal colonization and skin infections in patients with recurrent MRSA infections 6
- Add body decolonization with chlorhexidine gluconate (CHG) body wash daily for 5-14 days or dilute bleach baths (1 teaspoon per gallon of water for 15 minutes twice weekly) 2
Monitoring and Follow-up
- Routine surveillance cultures following decolonization are not recommended in the absence of active infection 2
- If symptoms persist or recur, consider obtaining cultures to assess for mupirocin resistance 5
Household and Environmental Considerations
- Implement good hygiene practices including regular handwashing, avoiding sharing personal items, and cleaning high-touch household surfaces 2
- Consider decolonization of household contacts if there is ongoing MRSA transmission within the household 2
- For healthcare workers or patients in healthcare settings, more aggressive decolonization may be warranted to prevent transmission 5
Common Pitfalls to Avoid
- Premature discontinuation of therapy before completing the full 5-day course can lead to treatment failure 1
- Failure to address underlying causes for recurrent infections (such as household transmission) may result in recolonization 2
- Using mupirocin in non-carriers is not recommended as it may lead to acquisition of exogenous strains and contribute to resistance 7
- Mupirocin should be reserved for confirmed carriers to minimize the risk of resistance development 7
Special Considerations
- Extranasal sites (throat, perineum) may remain colonized even after successful nasal decolonization, potentially leading to recolonization 7
- For persistent carriers with multiple recurrences despite appropriate therapy, consider evaluation for underlying immunodeficiency or other predisposing factors 2