What is the use of Mupirocin (Bactroban)?

From the Guidelines

Mupirocin is a topical antibiotic that should be used to treat bacterial skin infections, particularly those caused by Staphylococcus aureus, including methicillin-resistant strains (MRSA), as evidenced by the Infectious Diseases Society of America guidelines 1.

Key Points

• Mupirocin is effective against many gram-positive bacteria and some gram-negative bacteria.
• It works by inhibiting bacterial protein synthesis by binding to bacterial isoleucyl-tRNA synthetase, preventing the incorporation of isoleucine into bacterial proteins.
• Common indications include impetigo, folliculitis, small wounds, and surgical site infection prevention in MRSA carriers.
• For the treatment of bullous and nonbullous impetigo, mupirocin or retapamulin should be applied twice daily for 5 days 1.
• Mupirocin can also be used for nasal decolonization of MRSA, applied inside each nostril twice daily for 5-10 days 1.

Important Considerations

• Side effects are generally mild and may include burning, stinging, or itching at the application site.
• Resistance can develop with prolonged or repeated use, so it should be used only as prescribed and for the full treatment duration.
• Decolonization strategies, including mupirocin, may be considered for patients with recurrent skin and soft tissue infections (SSTI) or ongoing transmission in a well-defined, closely associated cohort 1.

Recommendations

• Mupirocin should be used as a first-line treatment for impetigo and other bacterial skin infections caused by Staphylococcus aureus, including MRSA, due to its efficacy and safety profile 1.
• Patients should be instructed to use mupirocin as directed and to complete the full treatment course to minimize the risk of resistance development.
• Decolonization strategies, including mupirocin, should be considered on a case-by-case basis, taking into account individual patient factors and the risk of ongoing transmission 1.

From the FDA Drug Label

CLINICAL PHARMACOLOGY ... Microbiology: Mupirocin is an antibacterial agent produced by fermentation using the organism Pseudomonas fluorescens. It is active against a wide range of gram-positive bacteria including methicillin-resistant Staphylococcus aureus (MRSA). ... Mupirocin has been shown to be active against most strains of Staphylococcus aureus and Streptococcus pyogenes, both in vitro and in clinical studies. (See INDICATIONS AND USAGE.)

The use of Mupirocin (Bactroban) is as an antibacterial agent for the treatment of infections caused by susceptible strains of bacteria, including Staphylococcus aureus and Streptococcus pyogenes 2.

• The indications for use are further detailed in the INDICATIONS AND USAGE section of the label, which is not provided here.
• Key points about the use of Mupirocin include its bactericidal activity at concentrations achieved by topical administration, and its unique mode of action that demonstrates no in vitro cross-resistance with other classes of antimicrobial agents.

From the Research

Use of Mupirocin (Bactroban)

• Mupirocin is indicated for primary and secondary skin infections, and for the eradication of nasal colonization of Staphylococcus aureus, particularly methicillin-resistant S. aureus (MRSA) 3, 4, 5, 6, 7
• It is active against a wide range of Gram-positive bacteria, including staphylococci and most streptococci, and is moderately active against Gram-negative bacteria 4, 5, 7
• Mupirocin 2% ointment has demonstrable efficacy for the treatment of both primary and secondary skin infections, including impetigo and infected wounds 4, 5, 6, 7
• Intranasal 2% calcium mupirocin has been shown to be effective in the eradication of nasal carriage of S. aureus, including MRSA 4, 5, 7
• The role of mupirocin in preventing staphylococcal infection is currently undergoing evaluation 4

Clinical Efficacy

• Mupirocin has shown excellent efficacy in both primary and secondary superficial skin infections, usually with at least 80% of patients being clinically cured or markedly improved, and over 90% eradication of the bacterial pathogen involved 5, 6
• Efficacy in impetigo and, to a somewhat lesser extent, infected wounds has been particularly convincingly demonstrated 5, 6, 7
• Limited evidence suggests that mupirocin may be as effective as other antibacterial agents, such as chlortetracycline, fusidic acid, and neomycin 5, 7

Safety and Tolerability

• Side effects are limited to local reactions (in less than 3% of patients) and are no more frequent than observed with the vehicle alone 5, 6, 7
• Adverse effects have included pruritus, burning, dry skin, and erythema 6, 7