How long should I take mupirocin (Bactroban) for a bacterial skin infection?

Duration of Mupirocin Treatment for Bacterial Skin Infections

For bacterial skin infections, mupirocin ointment should be applied to the affected area three times daily for 5-7 days, with reassessment if no clinical improvement is seen within 3-5 days. 1, 2

Standard Treatment Duration Guidelines

• Mupirocin 2% ointment should be applied three times daily to the affected area 1
• The FDA-approved label indicates that patients not showing clinical response within 3-5 days should be re-evaluated 1
• For most bacterial skin infections, the recommended duration is 5-7 days, depending on clinical response 2
• For impetigo and other primary skin infections, treatment typically averages 7-9 days 3

Treatment Duration for Specific Conditions

Primary Skin Infections

• For impetigo and other primary pyodermas, apply mupirocin three times daily until clinical resolution, typically 5-7 days 2, 3
• Clinical cure rates of over 90% have been demonstrated with this regimen 4, 3

Secondary Skin Infections

• For secondarily infected wounds, eczema, or other skin lesions, apply mupirocin three times daily for 5-7 days 2, 3
• Efficacy is comparable to oral antibiotics such as flucloxacillin for these infections 5, 6

Recurrent Infections/MRSA Decolonization

• For MRSA decolonization, a 5-day regimen of intranasal mupirocin twice daily is recommended 2
• For recurrent abscesses due to S. aureus, consider a 5-day decolonization regimen with intranasal mupirocin twice daily, combined with daily chlorhexidine washes 2

Monitoring and Follow-up

• If no clinical improvement is observed within 3-5 days, the patient should be re-evaluated for:

  • Potential resistance to mupirocin 1, 4
  • Need for systemic antibiotics 2
  • Presence of deeper infection requiring drainage 2

• Complete bacterial eradication typically occurs within 5-7 days of treatment 5, 3

Special Considerations

• Mupirocin has excellent efficacy against Staphylococcus aureus (including MRSA) and Streptococcus species, with bacterial eradication rates exceeding 90% 4, 7
• The cream formulation has similar efficacy to the ointment formulation and may improve patient compliance 6
• For more severe infections or those with systemic symptoms, oral or intravenous antibiotics may be needed instead of or in addition to topical mupirocin 2

Common Pitfalls to Avoid

• Avoid prolonged or repeated courses of mupirocin as this may lead to bacterial resistance 2, 4
• Do not use mupirocin for large areas of damaged skin or extensive burns as significant systemic absorption may occur 7
• For deeper infections or those with systemic symptoms, topical mupirocin alone is insufficient and systemic antibiotics should be considered 2