Can mupirocin (pseudomonic acid) and xeroform (petrolatum gauze) be used together?

Using Mupirocin and Xeroform Together

Yes, mupirocin and xeroform (petrolatum gauze) can be used together for wound management, as there are no known contraindications to their combined use.

Rationale for Combined Use

• Mupirocin is a topical antibiotic with excellent activity against Staphylococcus aureus (including MRSA) and Streptococcus species, which are common causes of skin infections 1
• Mupirocin 2% ointment is indicated for the topical treatment of impetigo and other localized skin infections caused by susceptible strains of S. aureus and S. pyogenes 1
• Xeroform (bismuth tribromophenate in a petrolatum base) serves as a non-adherent dressing that helps maintain a moist wound environment while providing a barrier function

Application Method

• Apply mupirocin 2% ointment directly to the wound bed first 2
• Then cover with xeroform gauze as the primary dressing
• The petrolatum base of xeroform is compatible with the polyethylene glycol vehicle of mupirocin ointment 3
• Change dressings 2-3 times daily, consistent with the recommended application frequency for mupirocin 4

Clinical Evidence Supporting Efficacy

• Mupirocin has demonstrated excellent efficacy in both primary and secondary superficial skin infections, with clinical cure or marked improvement in at least 80% of patients 5
• In clinical trials, mupirocin has shown high bacterial eradication rates (over 90%) for common wound pathogens 4
• For minor skin infections such as impetigo and secondarily infected skin lesions, mupirocin 2% topical ointment is specifically recommended in clinical practice guidelines 2

Potential Benefits of Combination

• Mupirocin provides antimicrobial activity while xeroform offers:
  • Protection of the wound bed
  • Absorption of exudate
  • Maintenance of a moist healing environment
  • Non-adherent properties that minimize trauma during dressing changes 6
• A study examining combination therapy with mupirocin and another agent (sucralfate) showed improved wound healing compared to mupirocin alone, suggesting mupirocin can be effectively combined with other topical agents 6

Precautions and Limitations

• Avoid using mupirocin on large areas of damaged skin or for prolonged periods, as this may increase the risk of side effects 3
• Local side effects such as burning, itching, and reddening occur in approximately 3% of patients using mupirocin, but these are generally mild 4
• If the wound shows signs of worsening infection despite treatment, reassess and consider systemic antibiotics 2
• For abscesses, incision and drainage remains the primary treatment, with topical or systemic antibiotics as adjunctive therapy 2

Duration of Treatment

• Typical duration of mupirocin treatment is 5-10 days 2
• Treatment should be individualized based on clinical response 2
• Prolonged use of mupirocin should be avoided to prevent development of resistance 2