Is it okay to use mupirocin (Bactroban) for 9 months in pediatric patients?

Mupirocin Use in Pediatric Patients for 9 Months

Mupirocin (Bactroban) is not recommended for prolonged use of 9 months in pediatric patients due to risk of bacterial resistance development and potential adverse effects. 1

Appropriate Duration of Mupirocin Use

• Mupirocin 2% topical ointment is recommended for short-term treatment of minor skin infections (such as impetigo) and secondarily infected skin lesions in pediatric patients 2
• Standard recommended duration for mupirocin treatment is 7-10 days for most skin infections 3
• FDA labeling warns that "prolonged use may result in overgrowth of nonsusceptible organisms, including fungi" 1
• Clinical studies supporting mupirocin's efficacy in pediatric patients have only evaluated short treatment courses, not extended use 4, 5

Risks of Extended Mupirocin Use

• Prolonged antibiotic exposure increases risk of developing bacterial resistance 1, 6
• Mupirocin resistance has been documented with extended or repeated use, particularly in healthcare settings 6
• Polyethylene glycol (the ointment base) can be absorbed from open wounds and damaged skin and is excreted by the kidneys, making prolonged exposure potentially problematic 1
• Extended use may disrupt normal skin flora, potentially leading to secondary fungal infections 1

Appropriate Use in Pediatric Patients

• Mupirocin has been established as safe and effective in pediatric patients aged 2 months to 16 years for short-term use 1
• For minor skin infections, mupirocin should be applied three times daily to affected areas 3, 4
• Clinical cure rates of approximately 90-100% have been demonstrated with short-course therapy 7, 8
• If impetigo has not improved in 3-5 days, patients should contact their healthcare provider 1

Alternative Approaches for Recurrent Skin Infections

For patients with recurrent skin infections requiring long-term management:

• Focus on preventive measures rather than extended antimicrobial use 2
• Maintain good personal hygiene with regular bathing and hand washing 2
• Keep any draining wounds covered with clean, dry bandages 2
• Consider chlorhexidine antiseptic washes as an adjunctive preventive therapy 3
• For recurrent infections, diluted bleach baths (1 teaspoon per gallon of bath water for 15 minutes twice weekly) may be beneficial 3
• Evaluate household contacts for evidence of Staphylococcus aureus infection 2
• Focus cleaning efforts on high-touch surfaces that may contact bare skin 2

When to Consider Systemic Therapy

• If skin infections recur despite appropriate topical therapy and preventive measures, systemic antibiotics may be necessary 2, 3
• For systemic therapy in pediatric patients with skin infections, options include clindamycin (if local resistance rates are low) 2
• Tetracyclines should not be used in children under 8 years of age 2

Conclusion

Mupirocin is highly effective for short-term treatment of skin infections in pediatric patients, but extended use for 9 months is not recommended due to risks of resistance development and potential adverse effects. For recurrent infections, focus should be on preventive measures rather than prolonged antimicrobial therapy.