Can mupirocin (Bactroban) ointment be used to treat bacterial skin infections in pediatric patients?

Mupirocin Ointment in Pediatric Patients

Yes, mupirocin ointment is safe and effective for treating bacterial skin infections in children and is specifically recommended by major guidelines for pediatric use. 1, 2

Approved Pediatric Indications

Mupirocin 2% ointment is FDA-approved and guideline-recommended for pediatric patients with impetigo and other superficial bacterial skin infections caused by Staphylococcus aureus and Streptococcus pyogenes. 1, 2

• Age range tested: Pediatric patients as young as 2 months have been studied in clinical trials with demonstrated safety and efficacy. 2
• Clinical efficacy in children: In FDA trials, mupirocin achieved 78% clinical cure rates in pediatric patients aged 2 months to 15 years with impetigo, compared to 36% with placebo. 2
• Pathogen eradication: 94-100% bacterial eradication rates were achieved in pediatric populations. 2

Dosing and Administration for Children

Apply mupirocin 2% ointment to affected lesions twice daily (bid) for patients with limited skin lesions. 1

• The Infectious Diseases Society of America (IDSA) 2014 guidelines specifically list pediatric dosing as "Apply to lesions bid" for impetigo treatment. 1
• Alternative sources recommend three times daily application for 5 days, though the IDSA guideline supports twice-daily dosing. 1, 3
• Treatment duration should typically be 5 days. 3

When to Use Topical vs. Oral Therapy

Mupirocin is appropriate only for children with localized infection and a limited number of lesions. 3

Switch to oral antibiotics if: 3

• Numerous lesions are present
• The infection is part of an outbreak
• No clinical response occurs within 3-5 days of topical therapy
• Signs of systemic involvement exist (fever, lymphadenopathy, extensive cellulitis)

Oral Antibiotic Alternatives When Needed

If oral therapy becomes necessary, IDSA-recommended pediatric regimens include: 1

• Cephalexin: 25-50 mg/kg/day divided into 3-4 doses
• Clindamycin: 20-30 mg/kg/day divided into 3 doses (preferred if MRSA suspected)
• Amoxicillin-clavulanate: 25 mg/kg/day (based on amoxicillin component) in 2 divided doses

Avoid tetracyclines (doxycycline, minocycline) in children under 8 years of age due to tooth discoloration risk. 1, 3

Important Caveats and Pitfalls

Long-term application of mupirocin is not recommended due to increased risk of bacterial resistance and skin sensitization. 4

• Limit use to short courses (5 days) for localized infections only. 3
• Do not use for widespread infections requiring systemic therapy. 4
• Monitor for signs of treatment failure or worsening infection, which warrant switching to oral antibiotics. 4
• Side effects are minimal (local reactions in <3% of patients), no more frequent than vehicle alone. 2

Comparative Effectiveness

Mupirocin demonstrates equivalent or superior efficacy compared to oral erythromycin in pediatric impetigo, with 96% clinical cure rates versus 78.5% for oral antibiotics in head-to-head trials. 2