Can mupirocin be applied to an open wound?

Can Mupirocin Be Applied to an Open Wound?

Yes, mupirocin can be safely and effectively applied to open wounds, including contaminated traumatic wounds, lacerations, abrasions, and sutured wounds. The FDA-approved labeling explicitly states mupirocin ointment is for external use on skin wounds, and multiple clinical studies demonstrate its efficacy in treating infected open wounds 1, 2.

FDA-Approved Indications and Application

• Mupirocin ointment 2% is FDA-approved for topical application to skin wounds, with standard dosing of a small amount applied three times daily to the affected area 1.
• The treated area may be covered with a gauze dressing if desired, making it suitable for open wound management 1.
• Clinical response should be evident within 3 to 5 days; if no improvement occurs, the patient should be re-evaluated 1.

Clinical Evidence Supporting Use in Open Wounds

• Mupirocin cream applied topically three times daily is as effective as oral cephalexin (given four times daily) for treating secondarily infected wounds including small lacerations, abrasions, and sutured wounds, with a 95% clinical success rate 2.
• In contaminated crush wounds, mupirocin demonstrated superior antibacterial activity against both Staphylococcus aureus and Streptococcus pyogenes compared to other topical agents, significantly lowering infection rates in both open and closed wounds 3.
• Mupirocin effectively eliminates bacteria from infected wounds within 4 days of topical application, including methicillin-resistant Staphylococcus aureus (MRSA) in burn wounds 4.

Important Safety Considerations and Contraindications

• Mupirocin ointment should NOT be used on mucosal surfaces as it is not formulated for this purpose 1.
• Exercise caution in patients with moderate to severe renal impairment because the polyethylene glycol base can be absorbed from open wounds and damaged skin and is excreted by the kidneys 1.
• Avoid use where absorption of large quantities of polyethylene glycol is possible, particularly in extensive open wounds with significant renal dysfunction 1.
• Discontinue use if irritation, severe itching, or rash occurs, as this may indicate sensitivity or chemical irritation 1.

Role in Traumatic Wound Management

While mupirocin is effective for open wounds, it's important to understand its place in the broader context of traumatic wound management:

• For traumatic open wounds requiring systemic therapy, oral amoxicillin-clavulanate is the first-line antibiotic according to the American Academy of Orthopaedic Surgeons, with doxycycline as an alternative for penicillin-allergic patients 5.
• Topical mupirocin serves as an adjunct or alternative to systemic antibiotics for localized wound infections, particularly when systemic therapy may not be necessary or tolerated 2.
• Proper wound irrigation with normal saline remains essential before considering any antibiotic therapy, whether topical or systemic 5.

Common Pitfalls to Avoid

• Do not use mupirocin as monotherapy for deep or extensively contaminated wounds that may require systemic antibiotics and surgical debridement 5.
• Avoid prolonged use beyond what is clinically necessary, as this may result in overgrowth of nonsusceptible organisms including fungi 1.
• Do not apply to large surface area wounds in patients with renal impairment due to risk of polyethylene glycol absorption 1.
• Avoid contact with eyes during application 1.