How to use mupirocin (antibiotic ointment) intranasal ointment?

How to Use Mupirocin Intranasal Ointment

Apply 2% mupirocin ointment into each nostril twice daily for 5-7 days to effectively decolonize Staphylococcus aureus nasal carriage and reduce infection risk. 1

Standard Application Protocol

Dosing and Frequency

• Apply approximately 0.5 grams (roughly a pea-sized amount) into each nostril twice daily 2
• Total treatment duration: 5-7 days for optimal decolonization 1, 3
• The 10-dose regimen (twice daily for 5 days) is superior to shorter 6-dose regimens, maintaining decolonization for at least 4 weeks post-treatment (89.5% vs 68.0% success rate, p=0.016) 3

Application Technique

• Insert the ointment directly into the anterior nares 4
• Apply to both nostrils even if colonization is detected in only one 2
• Local concentrations remain detectable for up to 72 hours after application 2

Clinical Context-Specific Protocols

Preoperative Surgical Decolonization

Start at least 48 hours before surgery and continue for 5-7 days total to decrease postoperative infections 1. This approach reduces Staphylococcus aureus infectious complications by 45% (RR 0.55,95% CI 0.34-0.89) compared to placebo 1. The evidence strongly supports routine decolonization without prior microbiological screening, as this strategy provides the best relative risk reduction and significant healthcare cost savings 1.

Combine with chlorhexidine: Pair mupirocin with twice-daily chlorhexidine mouthwash and daily chlorhexidine showers for comprehensive decolonization 1. This combination significantly reduces nasal MRSA carriage (RR 0.63,95% CI 0.52-0.75) 1.

Prevention of Recurrent Skin Infections

For immunocompetent patients with recurrent staphylococcal skin infections, apply a 5-day course of mupirocin every month 1, 5. This monthly regimen reduces positive nasal cultures by 73% (22 vs 83 positive cultures, p<0.001) and skin infections by 58% (26 vs 62 infections, p<0.002) over one year 5. However, note that a randomized trial in military personnel showed this approach did not reduce subsequent skin infections in MRSA carriers 1, suggesting efficacy may vary by population and setting.

Hospital Outbreak Control

During MRSA outbreaks, apply three times daily for 3 days before surgery, once upon return to the ward, then three times weekly for 2 weeks 6. This unselective blanket-use program prevented new MRSA colonization in all 84 treated patients and significantly decreased MRSA rates in the recovery room 6.

Important Clinical Considerations

Efficacy and Resistance

• Achieves >95% elimination of S. aureus (including MRSA) from nasal carriage in bacteriologically controlled studies 4
• Mupirocin resistance is rare but can occur; one study reported resistance in 1 of 34 patients during long-term monthly use 5
• No emergence of multidrug-resistant bacteria has been observed due to decolonization selection pressure 1

Adverse Effects

Mupirocin is generally well tolerated 2, 5. Reported adverse events are mild to moderate and include:

• Nasal symptoms: burning, stinging, pruritus, dryness, erythema, or swelling 2
• Respiratory problems (uncommon) 2
• No adverse effects were reported in the 1-year prevention trial 5

Common Pitfalls to Avoid

• Do not use shorter regimens: Six-dose protocols are significantly less effective than the standard 10-dose (5-day) regimen 3
• Do not delay initiation: Start at least 48 hours before surgery, not the day before 1
• Do not use mupirocin alone for surgical prophylaxis: Always combine with chlorhexidine-based oral and body decontamination for maximum benefit 1
• Do not screen before treating in surgical patients: Routine decolonization without prior screening is more cost-effective and provides better risk reduction than selective treatment 1