Mupirocin for Staph Infections
Yes, mupirocin ointment is indicated for the topical treatment of staph infections, specifically for impetigo and localized skin infections caused by Staphylococcus aureus, including methicillin-resistant strains (MRSA). 1, 2
Indications and Efficacy
- Mupirocin 2% ointment is FDA-approved for topical treatment of impetigo due to Staphylococcus aureus and Streptococcus pyogenes 1
- It demonstrates excellent activity against Staphylococcus aureus (including MRSA) and Streptococcus species, which are common causes of skin infections 2
- Mupirocin works by inhibiting bacterial protein synthesis through reversibly binding to bacterial isoleucyl transfer-RNA synthetase, providing a unique mechanism that limits cross-resistance with other antibiotics 1
Appropriate Use Cases
- Small localized staph infections: Mupirocin is appropriate for minor, superficial staph infections 2
- Impetigo: Particularly effective for this common staph-related skin infection 1
- Nasal decolonization: For recurrent staph infections, applying mupirocin in the anterior nares twice daily for the first 5 days each month can reduce recurrences by approximately 50% 3
- Secondary prevention: Monthly application of mupirocin has been shown to reduce both nasal colonization and subsequent skin infections in patients with recurrent staph infections 4
Application Method
- Apply a small amount of mupirocin 2% ointment directly to the affected area 2
- Typical treatment duration is 5-10 days 2
- For larger furuncles (boils) and carbuncles, incision and drainage is the primary treatment, with mupirocin potentially used as adjunctive therapy 3
Limitations and Cautions
- Mupirocin is not appropriate for extensive infections requiring systemic therapy 3
- For larger furuncles and all carbuncles, incision and drainage is required, with systemic antibiotics indicated if extensive surrounding cellulitis or fever is present 3
- Prolonged or indiscriminate use should be avoided to prevent development of resistance 2, 5
- Resistance to mupirocin has been reported, with rates varying geographically (up to 29.33% in some regions) 5
When to Consider Systemic Antibiotics Instead
- For staph infections with systemic signs (fever, extensive cellulitis) 3
- For deeper infections or those not responding to topical therapy within 5 days 3
- For immunocompromised patients with significant infections 3
- For severe or extensive infections, particularly those with SIRS (Systemic Inflammatory Response Syndrome) 3
Management of Recurrent Staph Infections
- For recurrent furunculosis, consider a decolonization regimen: 3
- Intranasal mupirocin twice daily
- Daily chlorhexidine washes
- Daily decontamination of personal items like towels and sheets
- For particularly persistent recurrent furunculosis, clindamycin 150 mg daily for 3 months decreases subsequent infections by approximately 80% 3
Practical Considerations
- Mupirocin has shown efficacy in treating MRSA burn wound infections, with significant reduction in viable organisms within 36 hours of application 6
- Recent studies confirm mupirocin's continued effectiveness for MRSA decolonization, though judicious use is essential to preserve its utility 7
- Monthly application of mupirocin in staph carriers has been shown to significantly reduce both nasal colonization and skin infections compared to placebo 4