Can Mupirocin Ointment Be Applied Directly to Wounds?
Yes, mupirocin ointment can and should be applied directly to wounds for specific indications, particularly for minor skin infections like impetigo, secondarily infected wounds, and small lacerations or abrasions. 1, 2
FDA-Approved Wound Application
The FDA label explicitly states that mupirocin ointment should be applied to the affected area three times daily, with the treated area optionally covered with a gauze dressing 2. This is the standard approved use for topical wound treatment, not just nasal application.
Specific Clinical Indications for Direct Wound Application
Primary and Secondary Skin Infections
- Impetigo: Mupirocin 2% ointment applied to lesions 2-3 times daily is specifically recommended for children with minor skin infections and secondarily infected skin lesions (such as eczema, ulcers, or lacerations) 1
- Small lacerations and abrasions: Mupirocin cream applied topically 3 times daily is as effective as oral cephalexin for treating secondarily infected wounds, with clinical success rates of 95% 3
- Sutured wounds: The same efficacy applies to infected sutured wounds 3
Staphylococcal Infections
- MSSA and MRSA wound infections: Mupirocin demonstrates over 90% bacterial elimination and clinical cure rates in skin infections 4
- Burn wounds: Mupirocin eliminated MRSA in 100% of treated burn wounds within 4 days in clinical trials, though it should only be used for burns covering less than 20% of total body surface area 5
Important Limitations and Contraindications
When NOT to Use Mupirocin on Wounds
- Mucosal surfaces: The ointment is NOT formulated for use on mucosal surfaces 2
- Large or extensive wounds: Avoid use on burns exceeding 20% of body surface area due to potential polyethylene glycol absorption through damaged skin, especially with renal impairment 2, 5
- Moderate to severe renal impairment: The polyethylene glycol base can be absorbed from open wounds and is renally excreted, posing risks in kidney dysfunction 2
Duration Limitations
- Maximum 5 days for burn wounds: Limited treatment duration prevents resistance development 5
- Re-evaluate at 3-5 days: If no clinical response occurs within 3-5 days, discontinue and consider alternative therapy 2
Nasal vs. Wound Formulations
Critical distinction: The standard mupirocin ointment (polyethylene glycol-based) is designed for wound application, while a separate paraffin-based formulation (Bactroban Nasal/mupirocin calcium ointment) exists specifically for intranasal use 2. The polyethylene glycol-based wound formulation should not be used intranasally due to potential stinging and drying 2.
Application Technique
- Apply a small amount to the affected area 3 times daily 2
- May cover with gauze dressing if desired 2
- Avoid contact with eyes 2
- For external use only 2
Common Pitfalls to Avoid
- Don't confuse formulations: Using the wound ointment in the nose or the nasal ointment on large wounds can cause adverse effects 2
- Don't use on extensive wounds with renal disease: Risk of polyethylene glycol toxicity 2
- Don't prolong treatment: Extended use beyond recommended duration increases resistance risk and fungal overgrowth 2, 5
- Don't use as monotherapy for deep infections: Mupirocin is appropriate only for superficial infections; deeper soft tissue infections require systemic antibiotics 1