Mupirocin (Topical)

As a topical antibiotic, Mupirocin is used to treat skin infections such as impetigo.

Overview

Sold under the trade name Bactroban among others, Mupirocin is an antibiotic which is applied as a cream to the skin to treat various types of superficial infection such as folliculitis or impetigo. It can also be used to rid the body of methicillin-resistant S. aureus (more commonly known as MRSA) when it is present in the nose' even if it presents no symptoms. However, due to concerns over the development of resistance to antibiotic medications, the use of Mupirocin is not recommended for periods exceeding ten days.

Mupirocin was first isolated in 1971 from Pseudomonas fluorescens, a rod-shaped, Gram-negative bacterium with an extremely versatile metabolism. It is currently regarded by the World Health Organization as an Essential Medicine, on account of its efficacy, low wholesale cost and versatility in treating a variety of bacterial infections.

This antibiotic is not suitable for the treatment of anaerobic bacterial infections, including yeast, chlamydia, mycoplasma and fungi.

Type Of Medicine

  • Topical antibiotic

Conditions Treated

Side Effects

Like many other medications, Mupirocin can cause some unwanted side effects along with its desired effects. The most common side effects reported by patients undergoing treatment with Mupirocin topical cream include the following:

  • Stinging, burning or pain on the site of application
  • Cracked, scaly or dry skin
  • Swelling, tenderness, pain or warmth on the skin
  • Ulcers, sores or white spots on the tongue, lips or inside of the mouth
  • Canker sores

As the patient continues to apply Mupirocin as prescribed, most of the previously mentioned symptoms should begin to subside. If any of these side effects persist over a prolonged period or appear to get worse, the patient should consult their doctor as soon as is practical. In many cases, a doctor or pharmacist will be able to recommend ways to alleviate certain symptoms using over the counter remedies or other prescription drugs.

Most patients only experience very minimal side effects, if they experience any whatsoever. Mupirocin is designed to defeat bacterial infections and as such it is typically prescribed because the benefits of ridding the skin of infection are greater than the risk of experiencing mild side effects.

Other side effects, which are experienced less frequently - albeit often enough to warrant mentioning - include the following:

  • Stomach or abdominal tenderness
  • Coughing
  • Dizziness
  • Difficulty coughing
  • Fast heartbeat
  • Welts or hives
  • Itching
  • Skin rash
  • Hive-like swelling on the eyelids, face, tongue, hands, throat, legs feet or genitals
  • Redness of the skin
  • Chest tightness
  • Severe abdominal cramps
  • Unusual weakness or tiredness
  • Severe, watery diarrhea which may also be bloody
  • Headache
  • Nausea

Because Mupirocin can cause dizziness on incredibly rare occasions, patients are advised to take great caution when driving or operating heavy machinery. This is to prevent the risk of injury to the patient or other road users.

Not all side effects may have been reported. Patients who experience side effects which are not listed on the literature provided with Mupirocin should consult their doctor or healthcare provider and report their findings to the FDA.

Dosage

As with all medicines, it is important for the patient to apply Mupirocin only as prescribed by a qualified doctor. Dosage may vary according to the individual needs of the patient, who should pay incredibly close attention to any instructions the prescribing doctor may impart. The instructions printed on the packaging may also be followed, as they should be similar to what the prescribing doctor decides upon. When determining the optimum dosage, a doctor will take various factors into account.

The strength of the topical cream, number of doses per week, time between doses and the length of time the patient is expected to undergo Mupirocin therapy will all play a part in determining the optimal dose size. In addition to this, the age, height, weight and condition of the patient will be considered also.

While the manufacturers provide general dose instructions, it should be reiterated that these are merely guidelines which can be altered by the patient's doctor.

Typical adult doses:

  • Secondary cutaneous bacterial infection: apply a small, pea-sized amount to the affected area three times a day, for a period not exceeding 10 days.
  • Nasal carriage infection with Staphylococcus aureus: approximately one-half of the contents of a tube of Mupirocin nasal ointment should be administered into each nostril twice per day (morning and evening) for a period of five days.
  • Impetigo: apply a small, pea-sized amount to the affected area three time a day, for a period not exceeding 10 days.

When applying Mupirocin in nasal ointment form, the nostrils should be closed and opened by repeatedly holding them together and releasing the grip repeatedly for about a minute. This ensures that the ointment is well-administered throughout the entirety of the nasal cavity. Mupirocin nasal ointment should not be used in conjunction with other intranasal products (such as menthol-vapor nasal treatments for colds and flu).

There are no recommended dose sizes for children below the age of three months for topical treatment or 12 years for treatment with nasal ointment. Instead, the manufacturer leaves dose sizes for pediatric patients in these age brackets to be decided by the prescribing doctor.

Patients are warned against taking more of this drug than has been prescribed. If they forget to apply a dose, the missed dose can be administered as soon as possible, unless it is too close to the time for the next dose to be applied. In this instance, the patient should simply omit the missed dose and continue with the dosing schedule as normal from the next dose onwards.

If the patient experiences any signs of overdose, they may require immediate medical attention. If the patient or their caregivers suspect an overdose, they should contact their local poison control center on 1800-222-1222 or the local emergency room on 911 as soon as possible.

Interactions

All drugs have the potential to interact with other medicines or chemicals within the body. These interactions can change the effects of a medicine, causing it to become ineffective in treating the condition it was prescribed to combat. In some cases, interactions can give rise to dangerous or even fatal side effects. For these reasons, it is important for the patient to keep a list of all medicines they are currently taking, including the dose size and frequency of treatment. This extends to over the counter remedies, complementary medicines, vitamins and herbal supplements as well as prescribed drugs.

While there are no known drug interactions for Mupirocin, this does not mean that no interactions exist. Patients who think they may have experienced an interaction between Mupirocin and another medication should consult their doctor or pharmacist and report their findings to the FDA.

Warnings

This medication should only be applied topically. It should not be taken orally. If this medicine gets in the eyes or mouth of the patient, they should rinse with water immediately.

The affected area should be cleaned prior to use. If possible, a cotton swab or gauze pad should be used to apply the correct amount of Mupirocin as determined by a qualified physician. Patients are advised to wash their hands before and after using this medication, to avoid spreading the infection.

Mupirocin should be used for the full prescribed length of time. Many patients find that their symptoms improve to the point where they are no longer noticeable before the infection has properly cleared and are tempted to discontinue use. Skipping doses or stopping Mupirocin therapy prematurely can increase the risk of further infection which may even be resistant to antibiotics.

Certain antibiotic medicines, including Mupirocin, can cause diarrhea. Diarrhea can often be the sign of a new infection. Patients who experience watery or bloody diarrhea while undergoing treatment with this medicine should contact their doctor. Patients are advised against using anti-diarrhea medications while undergoing treatment with Mupirocin.

Patients should discontinue use of this medication immediately if they experience:

  • Severe itching or irritation of the treated area of skin
  • Unusual peeling or blistering
  • Signs or symptoms of a new skin infection

Mupirocin should be used during pregnancy only if it is clearly needed, and if the benefits far outweigh any risk. There is insufficient data to suggest that the use of this drug can create a drug-related risk or dependency in the fetus. Systemic absorption of Mupirocin through intact skin is minimal but can occur on broken skin or open wounds. Because of this, women who are pregnant (or intending on becoming pregnant soon) are advised to discuss the risks of using this medication with their doctor.

Evidence exists to suggest that this medication is excreted into human breastmilk. The risk to the nursing infant is as low as 1 percent after topical application on the mother. Potential effects in the breastfed child because of the mother's use of Mupirocin should therefore be considered. Breastfeeding mothers may wish to refrain from breastfeeding while using this medication, or vice-versa.

Storage

Mupirocin nasal ointment should be stored at room temperature (20C to 25C). It should not be refrigerated.

Mupirocin topical cream should be stored below 25C, away from sources of heat and moisture. It is therefore unsuitable for storage in a bathroom cabinet, and should instead be kept in a dedicated, locked medical cabinet where possible.

When disposing of unwanted, unused or expired Mupirocin, the patient should do so in a safe and hygienic manner, in accordance with FDA guidelines and state law. This medication should not be poured down a drain or flushed down a toilet.

Summary

Mupirocin is a greatly beneficial ointment, but it can also pose a risk to some patients' particularly those who fail to communicate effectively with their physician or healthcare provider. As a treatment designed to alleviate symptoms of superficial cutaneous infections and MRSA infection of the nasal cavity, Mupirocin kills the bacteria responsible for such conditions.

However, it can also cause nausea, headaches, dizziness and pain at the site of treatment which can affect the day-to-day functioning of the patient. When taken correctly, this medication can provide relief from the symptoms associated with skin infections, which may have otherwise caused moderate to severe discomfort in the patient. To achieve these results, both patient and doctor need to work together to determine the most appropriate frequency of use and dose size.