What is the proper use and dosage of Mupirocin (mupirocin) topical ointment for skin infections?

Mupirocin Topical Ointment: Proper Use and Dosage

Apply mupirocin 2% ointment to the affected area three times daily for the treatment of impetigo caused by Staphylococcus aureus and Streptococcus pyogenes. 1

Indications

• Mupirocin ointment 2% is FDA-approved specifically for topical treatment of impetigo due to S. aureus and S. pyogenes 1
• It is highly effective for limited, localized skin lesions in the context of organized sports and athletic settings 2

Dosing and Application

• Apply a small amount of mupirocin ointment to the affected area three times daily 1
• The treated area may be covered with a gauze dressing if desired 1
• Treatment duration should be 5-7 days for topical therapy 3

When to Switch to Oral Antibiotics

Re-evaluate patients who do not show clinical response within 3-5 days 1. The American Academy of Pediatrics recommends switching to oral antibiotics if: 3

• The impetigo is extensive (not limited to small areas)
• No response to topical therapy after 3-5 days
• Systemic symptoms are present

Oral Antibiotic Options for Treatment Failure

For presumed methicillin-susceptible S. aureus (MSSA): 3, 4

• Dicloxacillin 250 mg four times daily (adults) or 12 mg/kg/day in 4 divided doses (children)
• Cephalexin 250-500 mg four times daily (adults) or 25 mg/kg/day in 4 divided doses (children)

For suspected or confirmed MRSA: 3, 4

• Clindamycin 300-450 mg three times daily (adults) or 10-20 mg/kg/day in 3 divided doses (children)
• Trimethoprim-sulfamethoxazole 1-2 double-strength tablets twice daily (adults) or 8-12 mg/kg/day in 2 divided doses (children)

Important Clinical Considerations

• Mupirocin resistance is increasingly documented, especially in areas with high MRSA prevalence 4
• Obtain cultures from lesions if treatment failure occurs, MRSA is suspected, or in cases of recurrent infections 3
• Penicillin alone is not effective for impetigo as it lacks adequate S. aureus coverage 3, 4
• For extensive impetigo, systemic therapy is preferred over topical treatment from the outset 4

Prevention of Spread

• Keep lesions covered with clean, dry bandages 3
• Maintain good personal hygiene with regular handwashing 3
• Avoid sharing personal items that contact the skin 3
• Clean high-touch surfaces regularly 2

Special Populations

• Pregnant patients: Cephalexin is considered safe; avoid tetracyclines 3, 4
• Children under 8 years: Avoid doxycycline and other tetracyclines 3, 4
• Athletes: Evaluate sparring partners and treat suspected cases to prevent outbreak spread 2

Common Pitfalls to Avoid

• Do not use mupirocin for extensive disease—switch to oral antibiotics immediately 3, 4
• Do not continue mupirocin beyond 3-5 days without clinical improvement 1
• Do not assume all impetigo is MSSA—consider MRSA in areas with high prevalence 4
• Do not use macrolides (erythromycin) as first-line due to increasing resistance rates 4