Mupirocin Indications
Mupirocin 2% ointment is FDA-approved for topical treatment of impetigo caused by Staphylococcus aureus and Streptococcus pyogenes, and clinical guidelines extend its use to other minor skin infections and secondarily infected skin lesions in both adults and children. 1
FDA-Approved Indication
- Primary indication: Topical treatment of impetigo due to Staphylococcus aureus and Streptococcus pyogenes 1
Guideline-Supported Clinical Uses
Pediatric Skin Infections
- Minor skin infections including impetigo in children 2
- Secondarily infected skin lesions such as infected eczema, ulcers, or lacerations 2
- Apply mupirocin 2% topical ointment 2-3 times daily for 5-10 days 3, 4
Adult Skin Infections
- Impetigo and other superficial primary skin infections 2
- Secondarily infected wounds and skin lesions 2
- Small furuncles as adjunctive therapy after incision and drainage when indicated 3
MRSA Decolonization
- Recurrent staph infections: Intranasal mupirocin twice daily for the first 5 days of each month reduces recurrences by approximately 50% 3
- Nasal carriage eradication: Intranasal application for MRSA carriers, though one military trial showed limited efficacy for preventing subsequent skin infections 2
- Decolonization regimen: Combined with daily chlorhexidine washes and decontamination of personal items for recurrent furunculosis 3
Antimicrobial Spectrum
- Excellent activity against Staphylococcus aureus (including MRSA) and Streptococcus species 3, 5
- Moderate activity against some Gram-negative bacteria, though this is not a primary indication 6, 7
- Unique mechanism: Inhibits bacterial isoleucyl-transfer RNA synthetase, minimizing cross-resistance with other antibiotic classes 5, 8
When Mupirocin is NOT Appropriate
Systemic Therapy Required
- Extensive infections with fever or systemic signs (SIRS) 3
- Deep soft tissue infections requiring IV antibiotics 2
- Complicated skin and soft tissue infections in hospitalized patients 2
- Large carbuncles or extensive surrounding cellulitis 3
Primary Treatment is Drainage
- Cutaneous abscesses: Incision and drainage is the primary treatment; mupirocin may serve as adjunctive therapy only 2
- Septic bursitis or other purulent collections where drainage is essential 2
Mucosal Surface Infections
- Penile mucosal infections: Alternative antimicrobial agents formulated for mucosal use are more appropriate 9
Important Clinical Caveats
- Duration limits: Avoid prolonged or indiscriminate use to prevent resistance development 3, 4
- Resistance monitoring: High-level mupirocin resistance (mupA and mupB genes) is increasingly reported worldwide 5
- Treatment failure: If no improvement within 5 days, reassess and consider systemic antibiotics 3
- Not monotherapy for severe infections: Immunocompromised patients with significant infections require systemic antibiotics 3