Mupirocin carriage

Mupirocin is employed topically in eradicating nasal and skin carriage of staphylococci, including methicilhn-resistantS to/)/ , colonization. 

Intranasal mupirocin in Bactroban Nasal ointment for eliminating nasal carriage of S aureus may be associated with irritation of mucous membranes caused by the polyethylene glycol vehicle. Mupirocin is not appreciably absorbed systemically after topical application to intact skin. 

Mupirocin is indicated for topical treatment of minor skin infections, such as impetigo. Topical application over large infected areas, such as decubitus ulcers or open surgical wounds, has been identified as an important factor leading to emergence of mupirocin-resistant strains and is not recommended. Mupirocin is also indicated for intranasal application for elimination of methicillin-resistant S aureus carriage by patients or health care workers. 

Recurrent impetigo, furunculosis, or other staphylococcal infections may be a result of pathogenic nasal carriage of S. aureus. To reduce postoperative complications, eradication of nasal colonization of S. aureus has been extended to colonized health care workers and other susceptible patients.14 Mupirocin has been found to be the most effective topical antibiotic for the elimination and is effective in reducing subsequent infections. When applied intranasally four times daily for five days, it has been shown to reduce nasal carriage for up to 1 year.77... 

Mupirocin (Fig. 10.16C) is the main fermentation product obtained from Ps. fluorescens. Other pseudomonic acids (B, C and D) are also produced. Mupirocin is active predominantly against staphylococci and most streptococci, but Enterococcus faecalis and Gram-negative bacilli are resistant. There is also evidence of plasmid-mediated mupirocin resistance in some clinical isolates of Staph, aureus. Mupirocin is employed topically in eradicating nasal and skin carriage of staphylococci, including methicillin-resistant Staph, aureus (MRSA) colonization. 

Nasal carriage of Staphylococcus aureus is associated with an increased risk of catheter-related infections and peritonitis. Prophylaxis with intranasal mupirocin (twice a day for 5 days every month) or mupirocin (daily) at the exit site can effectively reduce S. aureus infections. 

The nasal ointment is approved for eradication of S. aureus nasal carriage. Mupirocin is highly effective in eradicating S. aureus carriage. Because S. aureus colonization often precedes infection, eradication of carriage by intranasal application of mupirocin might reduce the risk of later infection. However, two clinical trials failed to demonstrate that mupirocin prophylaxis reduces nosocomial S. aureus infections. 

Mupirocin is effective in eradicating S. aureus carriage. The consensus is that patients who may benefit from mupirocin prophylaxis are those with proven S. aureus nasal colonization plus risk factors for distant infection or a history of skin or soft tissue infections. 

Pharmacokinetics and ciinical use Mupirocin is used topically and is not absorbed. This drag is indicated for impetigo caused by staphylococci (including methicillin-resistant strains), beta-hemolytic streptococci, and Streptococcus pyogenes. It is also used in-tranasally to eliminate staphylococcal carriage by patients and medical personnel. 

Martin, J., Perdreau-Remington, F., Kartalija, M., Pasi, O., Webb, M., Gerberding, J., Chambers, H., Tauber, M., and Lee, B. (1999) A randomized clinical trial of mupirocin in the eradication of Staphylococcus aureus nasal carriage in human immunodeficiency vims disease. J. Infect. Dis. 180, 896-899. 

A pilot study compared the use of 2% mupirocin nasal ointment and triclosan body wash (rou tine care) with 4% M. alternifolia essential oil nasal ointment and 5% tea tree oil body wash in 30 MRSA patients. The interventions lasted a minimum of 3 days, and screening for MRSA was undertaken 48 and 96 h posttreatment from sites previously colonized by the bacteria. There was no correlation between length of treatment and outcome in either group. Of the tea tree oil group, 33% were initially cleared of MRSA carriage, while 20% remained chronically infected at the end of treatment this was in comparison to routine care group of 13% and 53%, respectively. The trial was too small to provide signi cant results (Caelli et al., 2000). 

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