What is the typical treatment regimen for skin infections using mupirocin (Bactroban) ointment?

Mupirocin Ointment Treatment Regimen for Skin Infections

Apply mupirocin 2% ointment three times daily to the affected area for 5 days for localized skin infections like impetigo, or up to 10 days for other superficial staphylococcal/streptococcal infections. 1, 2

Standard Dosing and Application

• Apply a small amount of mupirocin 2% ointment directly to the affected area three times daily 2
• Treatment duration is 5 days for impetigo and localized infections 1
• Extend to 7-10 days for other superficial skin infections 1, 3
• The treated area may be covered with a gauze dressing if desired 2

When Mupirocin is Appropriate

Mupirocin is indicated for:

• Impetigo with limited lesions 1
• Localized staphylococcal or streptococcal skin infections 1, 3
• Secondarily infected skin lesions (infected eczema, ulcers, lacerations) 3
• Adjunctive therapy after incision and drainage of small abscesses 3

Critical Decision Point: When to Switch to Oral Antibiotics

Re-evaluate patients who show no clinical response within 3-5 days and switch to oral antibiotics 1, 2. The IDSA specifically recommends switching to systemic therapy if:

• Numerous lesions are present 1
• An outbreak situation exists 1
• No response occurs within 3-5 days 1

When Mupirocin is NOT Appropriate

Do not use mupirocin alone for:

• Extensive cellulitis or diffuse spreading infections - these require systemic antibiotics 1
• Deep soft tissue infections 3
• Complicated skin infections in hospitalized patients 3
• Infections with systemic signs (fever, extensive cellulitis, SIRS) - these require IV antibiotics like vancomycin 4, 3
• Larger furuncles and all carbuncles - these require incision and drainage as primary treatment, with systemic antibiotics if extensive surrounding cellulitis or fever is present 3

Special Use: Decolonization for Recurrent Infections

For patients with recurrent S. aureus skin infections despite optimizing wound care and hygiene:

Apply intranasal mupirocin twice daily for 5-10 days 4, 3. This should be combined with:

• Daily chlorhexidine washes for 5-14 days 4
• OR dilute bleach baths (1 teaspoon per gallon of water, 15 minutes twice weekly for 3 months) 4
• Daily decontamination of personal items (towels, sheets, clothes) 4

For ongoing prevention of recurrent furunculosis, apply intranasal mupirocin twice daily for the first 5 days of each month, which reduces recurrences by approximately 50% 3

Common Pitfalls to Avoid

• Do not use mupirocin for prolonged periods or indiscriminately - this promotes resistance 3
• Do not rely on mupirocin alone for infections requiring drainage - incision and drainage is the primary treatment for abscesses, with mupirocin only as adjunctive therapy 3
• Do not use for decolonization in outbreak settings - this may promote resistance per SHEA guidelines 1
• Local side effects (burning, itching, erythema) occur in less than 3% of patients but are no more frequent than vehicle alone 5