Treatment of Bacterial Skin Infections with Mupirocin
Mupirocin 2% topical ointment is indicated for the treatment of impetigo due to Staphylococcus aureus and Streptococcus pyogenes, and should be applied 2-3 times daily to affected areas for 5-7 days. 1, 2
Indications for Mupirocin
- Mupirocin is FDA-approved for the topical treatment of impetigo caused by S. aureus and S. pyogenes 1
- For children with minor skin infections (such as impetigo) and secondarily infected skin lesions (eczema, ulcers, or lacerations), mupirocin 2% topical ointment is recommended 2
- Mupirocin has excellent in vitro activity against staphylococci and most streptococci, making it effective for common bacterial skin pathogens 3
Administration and Dosing
- Apply mupirocin 2% ointment 2-3 times daily to affected areas 3, 4
- Treatment duration is typically 5-7 days but should be extended if the infection has not improved within this time period 2, 5
- Clinical cure or improvement has been demonstrated in over 90% of patients with bacterial pathogen eradication in most cases 3, 6
Treatment Algorithm for Bacterial Skin Infections
For Minor/Limited Skin Infections:
- Start with mupirocin 2% ointment applied 2-3 times daily to affected areas 3, 4
- Keep lesions covered with clean, dry bandages 2
- Monitor for clinical improvement within 3-5 days 5
For More Extensive Infections or Treatment Failure:
- Switch to oral antibiotics if the infection is extensive, not responding to topical therapy after 3-5 days, or associated with systemic symptoms 5
- For MSSA infections: dicloxacillin 250 mg four times daily or cephalexin 250-500 mg four times daily for adults 5
- For suspected MRSA: clindamycin 300-450 mg three times daily or trimethoprim-sulfamethoxazole 1-2 double-strength tablets twice daily 5, 2
Special Populations
- Pediatric patients: Mupirocin is safe and effective for children; avoid tetracyclines in children under 8 years of age 2, 5
- For hospitalized patients with complicated skin infections, consider IV antibiotics such as vancomycin, linezolid, daptomycin, or telavancin 2
- For recurrent infections: Consider a 5-day decolonization regimen with intranasal mupirocin twice daily, daily chlorhexidine washes, and daily decontamination of personal items 2
Prevention of Spread
- Keep draining wounds covered with clean, dry bandages 2
- Maintain good personal hygiene with regular bathing and hand washing 2
- Avoid reusing or sharing personal items that have contacted infected skin 2
- For recurrent infections, consider decolonization strategies including nasal mupirocin twice daily for 5-10 days 2
Important Considerations
- Mupirocin has fewer adverse effects than systemic antibiotics, is less expensive, easier to administer, and less likely to induce antibiotic resistance 6
- Side effects are limited to local reactions (in less than 3% of patients) including pruritus, burning, dry skin, and erythema 7
- Obtain cultures from lesions if there is treatment failure, MRSA is suspected, or in cases of recurrent infections 5
- Mupirocin cream formulation may offer similar or better efficacy compared to the ointment formulation in some cases 4