I am a healthy adult with Staphylococcus aureus colonization of my nose; how should I treat it?

Treatment of Nasal Staphylococcus Colonization in Healthy Adults

As a healthy adult with simple nasal colonization of Staphylococcus aureus without active infection or recurrent skin infections, you do not need treatment. 1, 2

Key Distinction: Colonization vs. Active Infection

• Colonization means the bacteria are present in your nose but causing no symptoms—this is normal and occurs in 20-40% of healthy people 3
• Active infection presents with purulent drainage, crusting, pain, redness around the nose, or systemic signs like fever—this requires treatment 1
• You should not receive antimicrobial therapy for simple colonization without signs of infection 1, 4

When Treatment IS Indicated

Treatment should only be pursued in these specific scenarios:

For Active Nasal Infection

• If you develop purulent drainage, crusting, pain, or erythema in your nose, use mupirocin 2% ointment to both anterior nares twice daily for 5-10 days 1
• Add systemic antibiotics only if extensive cellulitis, fever, or systemic manifestations develop 3, 1

For Recurrent Skin Infections

• If you experience 2 or more discrete skin infections at different sites over 6 months despite good hygiene, then consider decolonization 3, 2
• The decolonization regimen combines mupirocin 2% ointment to anterior nares twice daily for 5-10 days PLUS chlorhexidine body wash daily for 5-14 days 3, 1, 2
• Alternatively, use dilute bleach baths (¼ cup bleach per ¼ tub) for 15 minutes twice weekly for up to 3 months 3, 1

For Ongoing Household Transmission

• If multiple household members develop recurrent staph infections despite hygiene measures, all affected individuals should undergo simultaneous decolonization 3, 2
• Treating both patient and household contacts together results in fewer recurrences than treating the patient alone 1, 2

Why Routine Decolonization Is Not Recommended

• Mupirocin effectively reduces nasal colonization temporarily, but recolonization occurs in 40-60% of patients within 3 months 1
• Studies show mupirocin has not conclusively been shown to prevent infections in community settings among simple carriers 3, 1, 2
• Indiscriminate use promotes high-level mupirocin resistance, which has already been reported in some communities 3, 1, 2
• The evidence supporting decolonization comes primarily from healthcare settings (surgical patients, dialysis patients), not healthy community carriers 3, 5

Important Caveats

• Do not use mupirocin for simple nasal trauma or cuts without signs of infection—this promotes resistance without clinical benefit 1, 4
• Screening cultures are not routinely recommended before or after decolonization in the absence of active infection 3, 2
• If you later develop recurrent infections, the optimal decolonization regimen combines both nasal mupirocin and body antiseptics rather than mupirocin alone 3, 2
• Personal hygiene measures (not sharing towels, regular laundering of clothing and bedding, covering any wounds) are more appropriate for preventing transmission than antimicrobial decolonization in healthy carriers 3