Mupirocin

Mupirocin 2% is a topical antibiotic active against staphylococci and streptococci (DermNet). NICE NG153 recommends it three times daily for 5 days for Impetigo when Fusidic Acid resistance is suspected or confirmed. It is therefore third in line, after Hydrogen Peroxide Cream and fusidic acid. NICE notes that licences for use in infants vary between products. NICE NG190 does not list it for Infected Eczema (fusidic acid is the only topical named). DermNet lists infected dermatoses, including Atopic Dermatitis, among its uses, applied three times daily for up to 10 days. Side effects are local: itch, burning, redness, stinging and dryness. Because the ointment base (polyethylene glycol) can be absorbed through large open areas, DermNet advises caution with kidney impairment.

Mupirocin [treats] Impetigo Fusidic Acid [precedes] Mupirocin NICE NG153 [regulates] Mupirocin

Nasal decolonisation. For eczema or impetigo infections that keep coming back, NICE NG153 and NG190 say to send a skin swab and consider a nasal swab and Decolonisation. DermNet describes clearing the nostrils (and under fingernails) with fusidic acid or mupirocin twice daily for one week each month, often for 6 months. For MRSA carriers it gives 2–3 times daily for 3–5 days. In a toddler this means a small amount of ointment just inside each nostril. That should be done on a GP or specialist plan, not with a leftover tube.

Mupirocin [part-of] Decolonisation Mupirocin [treats] Staphylococcus aureus

Resistance. New Zealand allowed mupirocin over the counter from 1991 to 2000, then made it prescription-only again because mupirocin-resistant S. aureus rose (DermNet). In a New York paediatric dermatology clinic, 31.3% of S. aureus isolates from children were mupirocin-resistant, mostly high-level. Prior mupirocin use was the only independent risk factor (OR 19.2–26.5). 55.4% of the children had eczema, and 68.2% of MRSA isolates from children with atopic dermatitis resisted mupirocin (Antonov et al., AAC 2015). NICE warns that extended or recurrent use “may increase the risk of developing antimicrobial resistance”. Keep courses short, finish them, and throw the remainder away (DermNet).

Mupirocin [causes] Antimicrobial Resistance Atopic Dermatitis [relates] Mupirocin

Connections

• Fusidic Acid — switch when fusidic resistance suspected, source: NICE NG153
• Impetigo — alternative topical antibiotic, source: NICE NG153
• Hydrogen Peroxide Cream — antiseptic used before topical antibiotics, source: NICE NG153
• Decolonisation — nasal ointment for recurrent staph, source: DermNet 2015; NICE NG190
• MRSA — carrier decolonisation; high resistance in AD MRSA isolates, source: DermNet; Antonov 2015
• Antimicrobial Resistance — prior use is main driver, source: Antonov AAC 2015
• Staphylococcus aureus — target organism, source: DermNet
• Infected Eczema — not named in NG190 (fusidic acid only), source: NICE NG190