From the Guidelines
To decolonize MRSA from the genital area, a combination of topical antimicrobial treatments and hygiene practices is recommended, with a focus on nasal decolonization with mupirocin and topical body decolonization regimens with a skin antiseptic solution, such as chlorhexidine, as suggested by the Infectious Diseases Society of America guidelines 1. The most recent and highest quality study, published in 2014, provides guidance on the diagnosis and management of skin and soft tissue infections, including MRSA decolonization strategies 1.
Key Recommendations:
- Apply mupirocin 2% ointment to the affected genital area three times daily for 5-7 days.
- Use chlorhexidine 4% or povidone-iodine washes daily during the treatment period.
- Change underwear daily, using clean cotton underwear to reduce moisture and bacterial growth.
- Wash hands thoroughly before and after touching the area to prevent recontamination.
- Launder all clothing, towels, and bedding in hot water with detergent during treatment.
Additional Considerations:
- For persistent cases, oral antibiotics such as trimethoprim-sulfamethoxazole (Bactrim DS) twice daily for 7-10 days, doxycycline 100mg twice daily, or clindamycin 300mg three times daily may be prescribed by a healthcare provider.
- Complete the full course of any prescribed treatment even if symptoms improve early to ensure complete eradication of the bacteria. The guidelines emphasize the importance of ongoing reinforcement of hygiene measures in conjunction with decolonization strategies, as outlined in previous studies 1.
Important Notes:
- The treatment regimen should be tailored to the individual patient's needs and medical history.
- It is essential to follow the treatment plan and hygiene practices consistently to achieve effective decolonization and prevent recolonization.
From the FDA Drug Label
Mupirocin is active against a wide range of gram-positive bacteria including methicillin-resistant Staphylococcus aureus (MRSA). The FDA drug label does not answer the question.
From the Research
Decolonization of MRSA from the Genital Area
To decolonize MRSA from the genital area, the following methods can be considered:
- Vaginal colonization can be treated with povidone-iodine or, alternatively, with chlorhexidine ovula or octenidine solution, as stated in the study 2.
- A combination of topical therapy with orally administered antibiotics may increase success rates compared to topical therapy alone, especially in patients with extra-nasal colonization, including the genital area 3.
- Decolonization treatment with a combination of topical therapy, such as mupirocin nasal ointment and chlorhexidine body wash, and systemic antibiotics like rifampin and another antimicrobial agent, may be effective for extra-nasal MRSA decolonization, including the genital area 3.
Key Considerations
When attempting to decolonize MRSA from the genital area, consider the following:
- The decision to pursue decolonization treatment should be based on the treatment objective and the likelihood of successful decolonization, taking into account individual risk factors for treatment failure and the risk of recolonization 3.
- The effectiveness of decolonization strategies may vary depending on the location and prevalence of MRSA, as well as individual patient factors 4, 5.
- A combination of topical and systemic therapies may be necessary for successful decolonization, especially in cases of extra-nasal colonization 6, 3.