What is the recommended dose of mupirocin (antibiotic)?

Mupirocin Dosing Recommendations

For bacterial skin infections, apply mupirocin 2% ointment three times daily to the affected area for 5 days, as specified by the FDA label and supported by major infectious disease guidelines. 1

Standard Topical Dosing for Skin Infections

• Apply a small amount of mupirocin 2% ointment to affected areas three times daily for 5 days 1, 2
• The treated area may be covered with gauze dressing if desired 1
• For impetigo specifically, the three-times-daily regimen for 5 days is recommended by both the American Academy of Pediatrics and Infectious Diseases Society of America 2
• Patients not showing clinical response within 3-5 days should be re-evaluated 1

Intranasal Dosing for Decolonization

For eradication of nasal Staphylococcus aureus carriage (including MRSA), apply mupirocin 2% ointment intranasally twice daily for 5 days (10 total doses). 3

• This twice-daily for 5 days regimen is superior to shorter courses: 89.5% of patients remained decolonized for at least 4 weeks with 10 doses versus only 68.0% with 6 doses 4
• For recurrent skin infections, this 5-day intranasal decolonization may be repeated monthly, though efficacy in the current MRSA era remains uncertain 3
• Approximately 15 grams of ointment is needed for the complete twice-daily, 5-day intranasal course 5

Combined Decolonization Strategy for Recurrent Infections

When decolonization is considered for recurrent skin and soft tissue infections:

• Use intranasal mupirocin twice daily for 5 days PLUS daily bathing with chlorhexidine or dilute bleach baths 3
• Bleach bath concentration: 1 teaspoon per gallon of water (or 1/4 cup per 1/4 tub) for 15 minutes, twice weekly for 3 months 3
• This combined approach is preferred over mupirocin alone, though data on efficacy remain sparse 3

Critical Pitfalls to Avoid

• Do not discontinue treatment prematurely: Complete the full 5-day course even if symptoms improve quickly 5
• Do not use twice-daily dosing for active skin infections: The FDA-approved regimen for treating skin infections is three times daily, not twice daily 1
• Do not rely solely on mupirocin for extensive infections: If numerous lesions are present or no response occurs within 3-5 days, switch to oral antibiotics 2
• Wash hands thoroughly before and after each application to prevent spread of infection 5

When Mupirocin is NOT Appropriate

• Patients with numerous lesions or outbreak-associated impetigo should receive oral antibiotics instead 2
• For recurrent abscesses, incision and drainage remains the primary treatment; mupirocin decolonization is only adjunctive 3
• Oral antibiotics (cephalexin 25-50 mg/kg/day, dicloxacillin 25-50 mg/kg/day, or clindamycin 10-20 mg/kg/day for 7 days) should be considered if topical therapy fails 2