• Reevaluate those not showing a response after 3-5 days of use.
  • Mupirocin-resistant MRSA has increased due to increased use of this drug.
  • This drug has minimal activity against normal skin flora such as corynebacteria, micrococci, and the Propionibacterium organisms.

Studies on Efficacy

  • Two placebo controlled studies showed that mupirocin is better than placebo for the treatment of impetigo.

[Arch Dermatol. 1986 Nov; 122(11):1273-6.. RSM Int Congress Symposium. 1984; 80:85-93.]

  • The effectiveness of mupirocin to treat superficial skin infections is clinically equivalent to fusidic acid.

[Curr Med Res Opin. 1988; 11(2):142-8., Br J Dermatol. 2003 May;148(5):1010-7., J Am Acad Dermatol. 1989 Jun; 20(6):1083-7., J Infect. 1989 May; 18(3):221-9.]

  • Mupirocin was shown to be as effective as erythromycin for the treatment of impetigo.

[Antimicrob Agents Chemother. 1992 Feb; 36(2):287-90., J Pediatr. 1990 Nov; 117(5):827-9., Arch Dermatol. 1989 Aug; 125(8):1069-73.]

  • Mupirocin was shown to be as good as oral cephalexin for the treatment of infections secondary to wounds and abrasions.

[AHFS Drug Information. 2003; p. 3324.]

  • Mupirocin was shown to be better than bacitracin for the treatment of impetigo.

[Pediatr Infect Dis J. 1997 Jul; 16(7):708-10.]

Bacterial Resistance

With topical antibiotics, we have seen resistance to both fucidin and mupirocin. It is wise to use these medications for short periods of time only. Strategies have to be established to minimize or reverse the trend towards resistance to these drugs, e.g., using both drugs alternately may reduce resistance.

  • In southeastern Wisconsin, 100 isolates of S. aureus were collected in a laboratory serving several hospitals and clinics in the area and tested for mupirocin susceptibility. Only two of the isolates showed mupirocin resistance. The mupirocin-resistant isolates were from hospitalized patients with positive blood cultures.

[Infect Control Hosp Epidemiol. 2003 Apr; 24(4):300-1.]

  • In New Zealand, researchers have noted a steady rise in mupirocin resistance throughout the 1990s among patients with S. aureus infections, and suggest that it may be due in part to the over the counter availability of this product from 1991 to 2000.

[J Antimicrob Chemother. 2003 Mar; 51(3):613-7.]

  • In Norway, 255 isolates of S. aureus and S. pyogenes were collected from patients in three different areas in Norway and tested for fusidic acid resistance. Results demonstrated a high prevalence fusidic acid resistance, which was mainly due to the dissemination of clonally related fusidic acid resistant S. aureus.

[Scand J Infect Dis. 2003;35(2):84-9.]

  • In a small study of 46 patients with atopic eczema, 2%mupirocin + 0.1% betamethasone cream was compared to 2% fusidic acid + 0.1% betamethasone cream. There was no evidence to support the hypothesis that short-term treatment of atopic eczema with fusidic acid/steroid combination increases fusidic acid resistant S. aureus during a 2-week period.

[Br J Dermatol. 2003 May;148(5):1010-7.]

Mupirocin prophylaxis

For patients who are S. aureus carriers

  • Among patients receiving cardio-thoracic or general surgery, carriers who received this formulation beforehand had almost 50% fewer S. aureus surgical-site infections than carriers who received placebo.

[Surgery. 2003 Nov; 134(5 Suppl):S10-7.]

  • Perl, et al, found that prophylactic intranasal application of mupirocin did not significantly reduce the rate of S. aureus surgical-site infections over all, but did significantly decrease the rate of all nosocomial S. aureus infections among the patients who were S. aureus carriers.

[N Engl J Med. 2002 Jun 13; 346(24):1871-7.]

For nasal carriage

  • Grady, et al reported that mupirocin was proven to be effective in reducing the rates of nasal colonization of S. aureus and decreased postoperative nosocomial infections due to S. aureus.

[Surg Technol Int. 2003 Jun; 11:57-60.]

  • Laupland, et al concluded that although mupirocin is effective at reducing nasal carriage, routine use of topical intranasal mupirocin for infection prophylaxis is not supported by the currently available evidence.

[Clin Infect Dis. 2003 Oct 1; 37(7):933-8.]