From the Guidelines
To prevent recurrent MRSA infections in the nostrils, use mupirocin (Bactroban) 2% nasal ointment applied to each nostril twice daily for 5-10 days, as recommended by the Infectious Diseases Society of America 1. This treatment can be repeated if infections recur. For more persistent cases, consider combining this with chlorhexidine body washes (using 4% chlorhexidine gluconate solution) daily for 5-7 days, focusing on areas like the armpits, groin, and other skin folds. Some key points to consider when treating recurrent MRSA infections include:
- Keeping draining wounds covered with clean, dry bandages 1
- Maintaining good personal hygiene with regular bathing and cleaning of hands with soap and water or an alcohol-based hand gel, particularly after touching infected skin or an item that has directly contacted a draining wound 1
- Avoiding reusing or sharing personal items (eg, disposable razors, linens, and towels) that have contacted infected skin 1
- Considering a 5-day decolonization regimen twice daily of intranasal mupirocin, daily chlorhexidine washes, and daily decontamination of personal items such as towels, sheets, and clothes for recurrent S. aureus infection 1 Environmental decontamination is also important - wash bedding, towels, and clothing in hot water, and clean frequently touched surfaces with disinfectants. MRSA colonizes the nasal passages because the warm, moist environment provides ideal conditions for bacterial growth, and mupirocin works by inhibiting bacterial protein synthesis, effectively eliminating the reservoir of bacteria that leads to recurrent infections. It's worth noting that while oral antibiotics like doxycycline or trimethoprim-sulfamethoxazole may be recommended for severe or recurrent cases, the primary approach should focus on decolonization and hygiene measures 1.
From the Research
Recurrent MRSA in Nostril Prevention
- The use of mupirocin ointment has been shown to be effective in reducing nasal colonization with methicillin-resistant Staphylococcus aureus (MRSA) 2, 3.
- A study published in 2003 found that mupirocin was effective in eradicating MRSA from the nostrils of patients, with 78.5% of patients having negative post-treatment cultures on day 3 2.
- However, another study published in 2009 noted that relapses are common within several months after treatment with mupirocin, and that new antibiotics are needed to decolonize the nose due to rising bacterial resistance to mupirocin 4.
- A dose-ranging study published in 2013 found that a 10-dose regimen of intranasal 2% mupirocin calcium ointment was superior to a 6-dose regimen for decolonizing S. aureus from the anterior nares of patients and for maintaining the decolonized state for at least four weeks after therapy 5.
- Mupirocin nasal irrigations have also been used to treat chronic rhinosinusitis exacerbations due to MRSA, with one study finding that only 1 out of 27 repeat cultures grew MRSA after treatment 6.
- The use of mupirocin ointment has been recommended as part of comprehensive infection-control programs to reduce the risk of infection during institutional outbreaks of MRSA 3.
Prevention Strategies
- Applying 2% topical mupirocin ointment to the nostrils twice daily for 5 days has been shown to be effective in reducing MRSA colonization 2, 3.
- A 10-dose regimen of intranasal 2% mupirocin calcium ointment may be more effective than a 6-dose regimen for decolonizing S. aureus from the anterior nares of patients 5.
- Mupirocin nasal irrigations may be a useful treatment option for chronic rhinosinusitis exacerbations due to MRSA 6.