Version November 2024
Staphylococcus aureus (including methicillin-resistant) decolonization:
Note: For select patients who have recurrent S. aureus infection or warrant preoperative decolonization (Ref).
Intranasal (off-label use):
Note: Intranasal mupirocin ointment is no longer available in the United States.
Ointment: Apply into each nostril (an amount sufficient to cover the top of a cotton swab [~500 mg]) twice daily for 5 to 10 days in combination with a skin antiseptic (eg, chlorhexidine body wash); dose extrapolated from intranasal formulation (Ref). Note: Some experts suggest decolonization at discharge for hospitalized patients with methicillin-resistant S. aureus colonization or infection; in such cases, a 5-day course in combination with chlorhexidine body wash and mouthwash is repeated twice monthly for 6 months (Ref).
Superficial skin infection:
Folliculitis (off-label use): Topical: Ointment: Apply to affected area 3 times daily, typically for 7 days depending on severity and clinical response (Ref).
Impetigo (limited number of lesions): Topical: Ointment: Apply to affected area 2 to 3 times daily for 5 days (Ref).
Nasal vestibulitis (off-label use): Intranasal: Ointment: Apply to affected nostril(s) twice daily for 5 days (Ref).
Secondary skin infection (localized infection of wounds, burns, dermatitis, or other lesions): Topical: Cream, Ointment: Apply to affected area 2 to 3 times daily, typically for 7 to 14 days depending on severity and clinical response; if no response after 3 to 5 days, re-evaluate treatment (Ref).
There are no dosage adjustments provided in the manufacturer's labeling (has not been studied).
There are no dosage adjustments provided in the manufacturer's labeling.
Refer to adult dosing.
(For additional information see "Mupirocin: Pediatric drug information")
Staphylococcus aureus (methicillin-resistant or -susceptible) decolonization:
Nasal site: Note: Intranasal mupirocin ointment is no longer available in the United States; some dosing extrapolated from intranasal formulation.
Infants, Children, and Adolescents: Ointment: Limited data available: Topical: Apply a small amount (eg, approximately pea-sized) to both anterior nares twice daily for 5 to 10 days; often used concomitantly with a skin decontamination regimen (Ref).
Superficial skin infection:
Impetigo with limited lesions: Limited data available in ages <2 months: Infants, Children, and Adolescents: Ointment: Topical: Apply to affected area 2 to 3 times daily for 5 days; patients not showing clinical response after 3 to 5 days should be reevaluated (Ref).
Secondary skin infection with minor skin lesions: Cream (limited data in ages <3 months), Ointment (limited data available): Infants, Children, and Adolescents: Cream, Ointment: Topical: Apply to affected area 2 to 3 times daily for 7 to 10 days; patients not showing clinical response after 3 to 5 days should be reevaluated (Ref).
There are no dosage adjustments provided in the manufacturer's labeling (has not been studied).
There are no dosage adjustments provided in the manufacturer's labeling.
The following adverse drug reactions and incidences are derived from product labeling unless otherwise specified.
1% to 10%:
Dermatologic: Pruritus (≤1%), skin rash (≤1%), stinging of the skin (≤2%)
Gastrointestinal: Nausea (≤1%)
Local: Local pain (≤2%), localized burning (≤2%)
Nervous system: Headache (2%)
<1%:
Dermatologic: Cellulitis, dermatitis (including contract dermatitis), erythema of skin, xeroderma
Gastrointestinal: Abdominal pain, aphthous stomatitis
Infection: Secondary infection (wound)
Local: Local swelling, localized tenderness
Nervous system: Dizziness
Postmarketing: Hypersensitivity: Hypersensitivity reaction (including anaphylaxis and angioedema)
Hypersensitivity to mupirocin or any component of the formulation
Concerns related to adverse effects:
• Hypersensitivity: May be associated with systemic allergic reactions, including anaphylaxis, urticaria, angioedema, and generalized rash. If a systemic reaction occurs, discontinue use.
• Irritation: If sensitization or local irritation occurs, discontinue use.
• Superinfection: Prolonged use may result in fungal or bacterial superinfection, including C. difficile-associated diarrhea (CDAD) and pseudomembranous colitis; CDAD has been observed >2 months postantibiotic treatment.
Dosage form specific issues:
• Benzyl alcohol and derivatives: Some dosage forms may contain benzyl alcohol; large amounts of benzyl alcohol (≥99 mg/kg/day) have been associated with a potentially fatal toxicity ("gasping syndrome") in neonates; the “gasping syndrome” consists of metabolic acidosis, respiratory distress, gasping respirations, CNS dysfunction (including convulsions, intracranial hemorrhage), hypotension, and cardiovascular collapse (AAP ["Inactive" 1997]; CDC 1982); some data suggests that benzoate displaces bilirubin from protein binding sites (Ahlfors 2001); avoid or use dosage forms containing benzyl alcohol with caution in neonates. See manufacturer's labeling.
• Polyethylene glycol: Potentially toxic amounts of polyethylene glycol contained in some topical products may be absorbed percutaneously in patients with extensive burns or open wounds. Do not use polyethylene glycol-based ointments in conditions where absorption of large quantities of polyethylene glycol is possible, especially in the presence of moderate or severe renal impairment.
Other warnings/precautions:
• Appropriate use: For external use only. May cover treated areas with gauze dressing. Ointment should not be used with IV cannulae or at central IV sites because of the potential to promote fungal infections and antimicrobial resistance. Cream and ointment are not indicated for ophthalmic or nasal use or use on mucosal surfaces; in case of accidental contact in or near eyes, rinse well with water. If ointment applied intranasally (off-label use), may cause severe burning and tearing in eyes (resolves within days to weeks after discontinuation).
Some dosage forms may contain propylene glycol; in neonates large amounts of propylene glycol delivered orally, intravenously (eg, >3,000 mg/day), or topically have been associated with potentially fatal toxicities which can include metabolic acidosis, seizures, renal failure, and CNS depression; toxicities have also been reported in children and adults including hyperosmolality, lactic acidosis, seizures, and respiratory depression; use caution (AAP 1997; Shehab 2009).
Excipient information presented when available (limited, particularly for generics); consult specific product labeling. [DSC] = Discontinued product
Cream, External, as calcium [strength expressed as base]:
Generic: 2% (15 g, 30 g)
Kit, External:
Centany AT: 2% [DSC] [contains propylene glycol monostearate]
Ointment, External:
Centany: 2% (30 g [DSC]) [contains propylene glycol monostearate]
Generic: 2% (1 g, 15 g, 22 g)
May be product dependent
Cream (Mupirocin Calcium External)
2% (per gram): $1.81 - $16.37
Ointment (Mupirocin External)
2% (per gram): $0.51 - $3.89
Disclaimer: A representative AWP (Average Wholesale Price) price or price range is provided as reference price only. A range is provided when more than one manufacturer's AWP price is available and uses the low and high price reported by the manufacturers to determine the range. The pricing data should be used for benchmarking purposes only, and as such should not be used alone to set or adjudicate any prices for reimbursement or purchasing functions or considered to be an exact price for a single product and/or manufacturer. Medi-Span expressly disclaims all warranties of any kind or nature, whether express or implied, and assumes no liability with respect to accuracy of price or price range data published in its solutions. In no event shall Medi-Span be liable for special, indirect, incidental, or consequential damages arising from use of price or price range data. Pricing data is updated monthly.
Intranasal (ointment) (off-label route): After application into nostrils, press sides of nose together and gently massage to spread ointment throughout the insides of the nostrils for ~1 minute. Do not apply concurrently with any other intranasal products. Wash hands before and after application. In case of accidental contact in or near eyes, rinse well with water (Ref).
Topical (cream, ointment): For external use only; not for use in eyes or on mucous membranes (components may be absorbed systemically and cause drying and irritation). Apply small amount to affected area using gauze pad or cotton swab; area may be covered with a gauze dressing if desired. In case of accidental contact in or near eyes, rinse well with water. Wash hands before and after application.
Topical: Wash hands before and after application.
Ointment:
Nasal site: Apply to anterior nares (enough to cover nasal mucosa); press sides of the nose together and gently massage for ~1 minute after application to spread ointment throughout the inside of the nostrils. Not for use in eyes. In case of accidental contact in or near eyes, rinse well with water. Do not apply concurrently with any other intranasal products (Ref).
Skin site (eg, umbilical site, impetigo, secondary skin infection): For external use only; not for use in eyes or on mucous membranes (components may be absorbed systemically and cause drying and irritation). Apply a small amount to affected area using cotton swab or gauze pad; may cover area with gauze dressing if desired. In case of accidental contact in or near eyes, rinse well with water. Do not use concurrently with any other lotions, creams, or ointments.
Cream: Skin site (eg, umbilical site, impetigo, secondary skin infection): For external use only; not formulated for use on mucosal surfaces; do not apply into the eye or use intranasally (components may be absorbed systemically and cause drying and irritation). Apply a small amount to affected area using cotton swab or gauze pad; may cover area with gauze dressing if desired. In case of accidental contact in or near eyes, rinse well with water. Do not use concurrently with any other lotions, creams, or ointments.
Impetigo: Treatment of impetigo due to Staphylococcus aureus and Streptococcus pyogenes (topical ointment).
Secondary skin infection: Treatment of secondarily infected traumatic skin lesions (up to 10 cm in length or 100 cm2 in area) due to susceptible isolates of S. aureus and S. pyogenes (topical cream).
Folliculitis; Nasal vestibulitis; Peritoneal dialysis catheter exit-site or tunnel infection, prophylaxis; Staphylococcus aureus (including methicillin-resistant) decolonization
Bactroban may be confused with bacitracin, baclofen, Bactrim
None known.
There are no known significant interactions.
Systemic absorption following topical application is minimal.
It is not known if mupirocin is present in breast milk. Systemic absorption following topical application is minimal and significant exposure to a breastfeeding infant is not expected.
The American Academy of Breastfeeding Medicine recommends topical mupirocin for superficial skin infection associated with skin trauma in breastfeeding patients (ABM [Berens 2016]). Mupirocin is applied after breastfeeding in conjunction with cleaning the affected area. Topical treatment is not effective for systemic infection that may lead to mastitis (Livingstone 1999).
Per the manufacturer, if treatment to the breast and/or nipple is needed, the area should be thoroughly washed prior to breastfeeding to limit potential exposure of mupirocin to the infant; the decision to breastfeed during therapy should consider the risk of infant exposure, the benefits of breastfeeding to the infant, and benefits of treatment to the mother.
Binds to bacterial isoleucyl transfer-RNA synthetase resulting in the inhibition of protein synthesis
Absorption: Penetrates outer layers of skin; systemic absorption minimal through intact skin.
Protein binding: >97%.
Metabolism: Rapidly metabolized to monic acid (inactive) following IV or oral administration.
Half-life: IV: 20 to 40 minutes.
Excretion: Urine (as monic acid [inactive]).
آیا می خواهید مدیلیب را به صفحه اصلی خود اضافه کنید؟
