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Mupirocin Calcium Ointment for Long-term Eradication of S. aureus Nasal Carriage

The nares are often the primary site of Staphylococcus aureus colonization, and nasal carriage is particularly common in chronically ill persons, such as those with chronic renal failure or HIV disease. In most cases, invasive infection occurs after transfer of nasally carried S. aureus to entry points such as venous access devices or portals for hemodialysis or peritoneal dialysis. Investigators recently reported the short-term efficacy of mupirocin calcium ointment (MPO) in eradicating stable S. aureus nasal carriage in health care workers. Subjects were treated with either 2% MPO or placebo intranasally twice per day for 5 days. Significant reductions were noted in S. aureus carriage in the nose and hands at 3 days and in nasal carriage at 3 months in the MPO group as compared with the placebo group.

The investigators now report an extension of the original study. Sixty-three subjects from that study were examined at 6 months and 1 year after treatment. At 6 months, nasal carriage was 48% in the MPO-treatment group and 72% in controls. At one year, nasal carriage was 53% in the treatment group and 76% in controls. At 6 months, hand carriage of S. aureus was also significantly reduced in the treatment group versus controls (15% vs. 48%), but at 1 year the difference was no longer significant (39% vs. 44%, respectively).

Comment: Topical MPO ointment has proved to be an effective treatment for superficial S. aureus infection. It also appears to be an effective treatment for eradication of S. aureus nasal carriage, either as primary prophylaxis (i.e., before infection has occurred) or as secondary prophylaxis (i.e., after infection has occurred) to prevent recolonization of the nares. MPO is effective against methicillin-resistant S. aureus (MRSA) and can be used as primary prophylaxis in chronically ill nasal carriers, thereby avoiding expensive IV vancomycin therapy in those who might develop invasive infections.

— RA Johnson

Published in Journal Watch Dermatology October 1, 1994

Citation(s):

Doebbeling BN et al. Long-term efficacy of intranasal mupirocin ointment. A prospective cohort study of Staphylococcus aureus carriage. Arch Intern Med 1994 154 1505-1508.

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