MRSA Decolonization Treatment Protocol
For MRSA decolonization, the recommended treatment is nasal mupirocin 2% ointment applied twice daily for 5-10 days combined with daily chlorhexidine gluconate body washes for 5-14 days. 1, 2
When to Consider Decolonization
Decolonization therapy should be initiated in the following scenarios:
- Patients with recurrent MRSA skin and soft tissue infections (SSTIs) despite optimizing wound care and hygiene measures 1
- When ongoing MRSA transmission is occurring among household members or other close contacts despite optimizing hygiene measures 1
- Asymptomatic carriers are not routinely treated unless they fall into one of the above categories 3
Comprehensive Decolonization Protocol
First-Line Regimen
- Apply mupirocin 2% ointment to both anterior nares twice daily for 5-10 days 1, 2
- Use chlorhexidine gluconate 4% soap for daily full-body washing during the treatment period (5-14 days) 1, 2
- Alternative option: dilute bleach baths (1 teaspoon per gallon of water or ¼ cup per ¼ tub/13 gallons) for 15 minutes twice weekly for up to 3 months 1, 3
For Difficult-to-Eradicate Cases
- Consider adding systemic antibiotics for patients with extra-nasal colonization 4
- Combination therapy with rifampin and another antimicrobial agent (such as doxycycline) for 7 days may be effective for persistent cases 5, 4
- Consider intranasal povidone iodine as an alternative when mupirocin resistance is suspected or confirmed 6, 7
Essential Hygiene Measures
All decolonization protocols should be accompanied by strict hygiene measures:
- Keep draining wounds covered with clean, dry bandages 1
- Maintain good personal hygiene with regular bathing 1, 3
- Clean hands frequently with soap and water or alcohol-based hand sanitizer, particularly after touching infected skin 1
- Avoid sharing personal items (razors, linens, towels) that may contact skin 1
- Clean high-touch surfaces (counters, doorknobs, bathroom fixtures) with standard cleaning products 1
Management of Household Contacts
- Evaluate symptomatic contacts for evidence of MRSA infection and treat accordingly 1
- Consider nasal and topical body decolonization of asymptomatic household contacts when there is ongoing transmission 1, 3
Monitoring and Follow-up
- Screening cultures prior to decolonization are not routinely recommended if at least one prior infection was documented as MRSA 1, 3
- Surveillance cultures following decolonization are not routinely recommended in the absence of active infection 1, 3
Potential Pitfalls and Considerations
- Mupirocin resistance is emerging (22.5% of MRSA strains in some settings), which may lead to treatment failure 6, 5
- Hexachlorophene should not be used in infants under 2 months of age due to risk of neurological complications 1, 3
- Decolonization may provide only temporary clearance, with recolonization occurring after discontinuation of therapy 1, 3
- Treatment success is more likely in areas with low MRSA prevalence due to reduced risk of recolonization 4
- The combination of mupirocin and chlorhexidine has been shown to eradicate MRSA colonization in 74% of treated patients at 3 months compared to only 32% in untreated individuals 5