Mupirocin Should NOT Be Applied Directly to Abscesses
Mupirocin ointment is not indicated for abscess treatment—incision and drainage is the primary therapy for abscesses, with mupirocin reserved for superficial skin infections like impetigo, not purulent collections. 1
Primary Treatment for Abscesses
- Incision and drainage is the definitive treatment for cutaneous abscesses, furuncles, and carbuncles 1
- Incision and drainage alone achieves 85-90% cure rates regardless of whether antibiotics are used 1
- Simply covering the surgical site with a dry dressing after drainage is usually the most effective wound management 1
When Mupirocin IS Appropriate
Mupirocin 2% topical ointment is specifically indicated for:
- Minor skin infections such as impetigo 1
- Secondarily infected skin lesions including eczema, ulcers, or lacerations 1
- Pediatric patients with these superficial infections 1
The FDA-approved dosing is application three times daily to the affected area, which may be covered with gauze 2
Systemic Antibiotics for Abscesses (Not Topical Mupirocin)
If antibiotics are needed as adjunct to incision and drainage, use oral systemic agents, not topical mupirocin 1:
- Clindamycin (covers both MRSA and streptococci) 1
- TMP-SMX (MRSA coverage; add beta-lactam for streptococcal coverage) 1
- Doxycycline or minocycline (MRSA coverage; add beta-lactam for streptococcal coverage) 1
Indications for Adding Systemic Antibiotics to Drainage:
- Presence of SIRS (fever >38°C, tachycardia >90, tachypnea >24, WBC >12,000 or <4,000) 1
- Markedly impaired host defenses 1
- Multiple abscesses or evidence of spreading cellulitis 1
- Failed initial drainage alone 1
Role of Mupirocin in Recurrent Abscesses
For prevention of recurrent S. aureus abscesses (not acute treatment), consider a 5-day decolonization regimen 1:
- Intranasal mupirocin twice daily for 5 days 1
- Combined with daily chlorhexidine body washes 1
- Plus decontamination of personal items (towels, sheets, clothes) 1
However, evidence for this approach in the MRSA era is limited, with one randomized trial showing intranasal mupirocin alone did not reduce subsequent skin infections 1
Critical Distinction
The term "cellulitis" should not be used for purulent collections like abscesses 1. This distinction is crucial because:
- Cellulitis = primary treatment is systemic antimicrobial therapy 1
- Abscess = primary treatment is drainage, with antimicrobials having a subsidiary role or being unnecessary 1
Applying mupirocin to an undrained abscess would be ineffective since the drug cannot penetrate the purulent collection, and the primary pathology (pus accumulation) requires mechanical drainage 1.