Mupirocin Dosing and Treatment Duration
For bacterial skin infections like impetigo, apply mupirocin 2% ointment three times daily for 5-10 days, and for MRSA nasal decolonization, apply twice daily to the anterior nares for 5-10 days. 1, 2
Bacterial Skin Infections (Impetigo and Other Superficial Infections)
Standard Dosing Regimen
- Apply a small amount of mupirocin 2% ointment to the affected area three times daily 1
- Treatment duration: 5-10 days 3
- The treated area may be covered with gauze dressing if desired 1
- Re-evaluate patients who show no clinical response within 3-5 days 1
Clinical Efficacy
- Mupirocin demonstrates excellent activity against Staphylococcus aureus (including MRSA) and Streptococcus species, achieving over 90% bacterial eradication and clinical cure rates in superficial skin infections 3, 4
- Particularly effective for impetigo and infected wounds 4
Important Limitations
- Mupirocin is NOT appropriate for extensive infections requiring systemic therapy 3
- For abscesses, furuncles, and carbuncles, incision and drainage is the PRIMARY treatment—mupirocin serves only as adjunctive therapy 3, 2
- Systemic antibiotics are required when fever or extensive surrounding cellulitis is present 3
MRSA Nasal Decolonization
Standard Decolonization Protocol
- Apply mupirocin 2% ointment to each nostril (anterior nares) twice daily for 5-10 days 2, 3
- The 10-dose regimen (twice daily for 5 days) is superior to shorter regimens, maintaining decolonization for at least 4 weeks post-treatment (89.5% vs 68.0% success rate with 6 doses) 5
Enhanced Decolonization Strategy
For optimal MRSA eradication, combine mupirocin with additional measures: 2, 3
- Intranasal mupirocin 2% twice daily for 5-10 days PLUS
- Daily chlorhexidine body washes for 5-14 days OR dilute bleach baths (¼-½ cup per full bath)
- Twice-daily chlorhexidine mouthwash for oropharyngeal decontamination 3
Clinical Context for Decolonization
Decolonization should be considered when: 2
- Recurrent skin and soft tissue infections occur despite optimizing wound care and hygiene
- Ongoing transmission is occurring among household members or close contacts
- Preoperative prophylaxis is needed (starting at least 48 hours before surgery for 5-7 days total) 3
Efficacy and Limitations
- Intranasal mupirocin achieves over 95% eradication of nasal S. aureus carriage, including MRSA 6
- However, one randomized trial in military personnel showed that nasal mupirocin alone did NOT reduce subsequent skin infections, highlighting that decolonization efficacy may vary by population and setting 2
Prevention of Recurrent Infections
Monthly Prophylaxis Regimen
- For recurrent staph infections: Apply mupirocin to anterior nares twice daily for the first 5 days of each month, which reduces recurrences by approximately 50% 3
- Alternative: Clindamycin 150 mg daily for 3 months decreases recurrent furunculosis by approximately 80% 3
Adjunctive Hygiene Measures
Must be implemented alongside decolonization: 2
- Keep draining wounds covered with clean, dry bandages
- Regular hand hygiene with soap and water or alcohol-based gel
- Avoid sharing personal items (razors, linens, towels)
- Daily decontamination of personal items 3
- Clean high-touch surfaces with appropriate cleaners 2
Critical Pitfalls to Avoid
Resistance Concerns
- Avoid prolonged or indiscriminate use to prevent resistance development 3, 7
- High-level mupirocin resistance (MIC >512 µg/mL) is associated with treatment failure 3
- Resistance rates are increasing, particularly among MRSA isolates in areas with widespread mupirocin use 7
When Mupirocin is Insufficient
Switch to systemic antibiotics for: 3
- Deep soft tissue infections or complicated skin infections
- Systemic signs (fever, extensive cellulitis, SIRS)
- Immunocompromised patients with significant infections
- Infections not responding to topical therapy within 5 days