Mupirocin Nasal Ointment for MRSA Decolonization
Apply mupirocin 2% ointment to the anterior nares twice daily for 5-10 days to eradicate MRSA nasal colonization, but only use this in specific clinical scenarios—not for routine screening-detected asymptomatic carriers. 1, 2
When to Use Mupirocin for MRSA Decolonization
Do NOT routinely decolonize asymptomatic MRSA carriers. 2 The Infectious Diseases Society of America explicitly reserves treatment for specific situations:
- Recurrent skin and soft tissue infections that persist despite optimizing wound care and hygiene measures 1, 2
- Ongoing transmission among household members or close contacts despite hygiene interventions 1, 2
- Following treatment of active infection in symptomatic patients 1, 2
Recommended Dosing Regimen
The standard regimen is mupirocin 2% ointment applied to anterior nares twice daily for 5-10 days. 1, 2
- The 10-dose regimen (twice daily for 5 days) is superior to shorter 6-dose regimens, maintaining decolonization for at least 4 weeks in 89.5% of patients versus 68% with 6 doses 3
- Apply approximately 0.5 grams into each nostril with each application 4
Enhanced Decolonization for Recurrent Cases
For patients with recurrent infections, combine nasal mupirocin with topical body decolonization. 1, 2 The Infectious Diseases Society of America recommends:
- Mupirocin 2% to anterior nares twice daily for 5-10 days PLUS 1, 2
- Chlorhexidine body washes for 5-14 days OR dilute bleach baths 1, 2
- Bleach bath concentration: 1/4 to 1/2 cup bleach per full bathtub 2
Essential Concurrent Hygiene Measures
Decolonization strategies must be combined with ongoing hygiene reinforcement—mupirocin alone is insufficient. 1, 2 The Infectious Diseases Society of America mandates:
- Keep draining wounds covered with clean, dry bandages 1, 2
- Hand hygiene with soap and water or alcohol-based gel after touching infected areas 1, 2
- Avoid sharing personal items (razors, linens, towels) 1
- Clean high-touch surfaces (counters, doorknobs, bathtubs, toilet seats) with commercial cleaners 1, 2
- Treat interdigital toe space infections/maceration to eliminate colonization reservoirs 2
Household Contact Management
Evaluate and treat symptomatic household contacts first, then consider decolonization of asymptomatic contacts when ongoing transmission is documented. 1, 2 Evidence suggests treating both patient and household contacts together results in fewer recurrences than treating the patient alone 2
Critical Limitations and Resistance Concerns
High-level mupirocin resistance has been reported in community settings, making susceptibility testing important before widespread use. 2, 5 Key caveats:
- Mupirocin effectively reduces nasal colonization but has not conclusively been shown to prevent infections in community settings 2
- Mupirocin-resistant MRSA often persists after treatment—only 25-27.7% of high-level resistant strains are eradicated versus 91% of susceptible strains 5
- Prolonged or indiscriminate use should be avoided to prevent resistance development 2, 6
- Consider sampling MRSA populations for mupirocin susceptibility prior to incorporating into infection control programs 5
Surveillance Culture Recommendations
Do NOT perform routine screening cultures or post-decolonization surveillance cultures in the absence of active infection. 2 Pre-decolonization cultures are unnecessary if prior MRSA infection was documented 2
Common Pitfalls to Avoid
- Do not use mupirocin for routine decolonization of asymptomatic carriers detected through screening programs—this promotes resistance without proven benefit 2
- Do not rely on mupirocin alone—hygiene measures and environmental cleaning are equally critical 1, 2
- Do not use shortened regimens—the 10-dose (5-day) course is significantly more effective than 6-dose regimens 3
- Do not forget to address body colonization sites in recurrent cases—nasal decolonization alone may be insufficient 1, 2