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Mupirocin: Drug information

Mupirocin: Drug information
(For additional information see "Mupirocin: Patient drug information" and see "Mupirocin: Pediatric drug information")

For abbreviations, symbols, and age group definitions used in Lexicomp (show table)
Brand Names: US
  • Bactroban Nasal [DSC];
  • Bactroban [DSC];
  • Centany;
  • Centany AT
Pharmacologic Category
  • Antibiotic, Topical
Dosing: Adult

Note: Bactroban Nasal has been discontinued in the United States for more than 1 year.

Peritoneal dialysis catheter exit-site or tunnel infection, prophylaxis

Peritoneal dialysis catheter exit-site or tunnel infection, prophylaxis (off-label use):

Topical: Cream: Apply once daily to catheter exit site to prevent infection (ISPD [Li 2016]; Tsai 2018). Note: Cream is preferred to ointment, which may damage some catheters (Khandelwal 2003).

Staphylococcus aureus decolonization

Staphylococcus aureus (including methicillin-resistant) decolonization:

Note: For select patients who have recurrent S. aureus infection or warrant preoperative decolonization.

Intranasal: Ointment: Apply approximately one-half of the ointment from the single-use 1 g tube into each nostril twice daily for 5 to 10 days in combination with a skin antiseptic (eg, chlorhexidine body wash) (ASHP/IDSA/SIS/SHEA [Bratzler 2013]; Bode 2010; IDSA [Liu 2011]; Lee 2013). As an alternative to single-use tubes, 500 mg (an amount sufficient to cover the top of a cotton swab) from a 22 g tube can be applied into each nostril. 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 (Huang 2019).

Superficial skin infection

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 (Bork 1989; Gilbert 1989).

Impetigo (limited number of lesions): Topical: Ointment: Apply to affected area 2 to 3 times daily for 5 days (Bork 1989; Gilbert 1989; IDSA [Stevens 2014]).

Nasal vestibulitis (off-label use): Intranasal: Ointment: Apply to affected nostril(s) twice daily for 5 days (Bhattacharyya 2020; Wang 2022).

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 (Gilbert 1989; Weston 2021; White 1989; manufacturer's labeling).

Dosing: Kidney Impairment: Adult

There are no dosage adjustments provided in the manufacturer's labeling (has not been studied).

Dosing: Hepatic Impairment: Adult

There are no dosage adjustments provided in the manufacturer's labeling.

Dosing: Pediatric

(For additional information see "Mupirocin: Pediatric drug information")

Note: Bactroban Nasal has been discontinued in the US for >1 year.

MRSA decolonization, nasal

MRSA decolonization, nasal: Topical: Intranasal ointment:

Infants and Children: Limited data available: Apply a small amount twice daily for 5 to 10 days (IDSA [Liu 2011])

Children ≥12 years and Adolescents: Apply 500 mg (1/2 of unit-dose tube) twice daily for 5 to 10 days (IDSA [Liu 2011])

MRSA or impetigo, treatment; minor skin infection ora limited number of infected lesions

MRSA or impetigo, treatment; minor skin infection or a limited number of infected lesions: Infants, Children, and Adolescents: Topical: Cream, Ointment: Apply small amount 3 times daily for 5 to 10 days; patients not showing clinical response after 5 days should be reevaluated (IDSA [Liu 2011]; IDSA [Stevens 2014])

Dosing: Kidney Impairment: Pediatric

There are no dosage adjustments provided in the manufacturer's labeling (has not been studied).

Dosing: Hepatic Impairment: Pediatric

There are no dosage adjustments provided in the manufacturer's labeling.

Dosing: Older Adult

Refer to adult dosing.

Dosage Forms: US

Excipient information presented when available (limited, particularly for generics); consult specific product labeling. [DSC] = Discontinued product

Cream, External, as calcium [strength expressed as base]:

Bactroban: 2% (15 g [DSC], 30 g [DSC])

Generic: 2% (15 g, 30 g)

Kit, External:

Centany AT: 2% [contains propylene glycol monostearate]

Ointment, External:

Centany: 2% (30 g) [contains propylene glycol monostearate]

Generic: 2% (1 g, 15 g, 22 g)

Ointment, Nasal, as calcium [strength expressed as base]:

Bactroban Nasal: 2% (1 g [DSC])

Generic Equivalent Available: US

May be product dependent

Product Availability

Bactroban Nasal has been discontinued in the United States for more than 1 year.

Administration: Adult

Intranasal ointment: After application into nostrils, press sides of nose together and gently massage to spread ointment throughout the insides of the nostrils for ~1 minute. Packaged in single-use tubes; discard after use; do not re-use. 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. Wash hands before and after application.

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.

Administration: Pediatric

Topical: Wash hands before application.

Intranasal ointment: Apply to anterior nares; press sides of the nose together and gently massage for 1 minute after application to spread ointment throughout the inside of the nostrils. Packaged in single-use tubes; discard after use; do not reuse. 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. Wash hands after application.

Topical cream, ointment: 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.

Use: Labeled Indications

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).

S. aureus (including methicillin-resistant) decolonization: Eradication of nasal colonization with methicillin-resistant S. aureus (MRSA) in adult and pediatric patients ≥12 years of age and health care workers as part of a comprehensive infection control program to reduce the risk of infection among patients at high risk of MRSA infection during institutional outbreaks of infections with this microorganism (intranasal ointment).

Use: Off-Label: Adult

Folliculitis; Nasal vestibulitis; Peritoneal dialysis catheter exit-site or tunnel infection, prophylaxis

Medication Safety Issues
Sound-alike/look-alike issues:

Bactroban may be confused with bacitracin, baclofen, Bactrim

Adverse Reactions

The following adverse drug reactions and incidences are derived from product labeling unless otherwise specified.

1% to 10%:

Central nervous system: Headache (2% to 9%), localized burning (<4%), stinging sensation (<2%)

Dermatologic: Pruritus (≤2%), skin rash (≤1%)

Gastrointestinal: Nausea (1% to 5%), dysgeusia (3%)

Local: Local pain (<2%)

Respiratory: Rhinitis (6%), respiratory congestion (5%), pharyngitis (4%), cough (2%)

<1%, postmarketing, and/or case reports: Abdominal pain, aphthous stomatitis, blepharitis, cellulitis, Clostridioides difficile-associated diarrhea, contact dermatitis, dermatitis, diarrhea, dizziness, epistaxis, erythema, hypersensitivity reaction, increased wound secretion, localized edema, localized tenderness, otalgia, urticaria, wound infection (secondary), xeroderma, xerostomia

Contraindications

Hypersensitivity to mupirocin or any component of the formulation

Warnings/Precautions

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.

Disease-related concerns:

• Renal impairment: Topical ointment and intranasal: Use with caution in patients with renal impairment (has not been studied).

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. Avoid contact with eyes; in case of accidental contact in or near eyes, rinse well with water.

- Intranasal: May cause severe burning and tearing in eyes (resolves within days to weeks after discontinuation). Available in single-use tubes to decrease risk of contamination.

- Topical cream and ointment: Not for ophthalmic or nasal use or use on mucosal surfaces. May cover treated areas with gauze dressing.

• Limitations of use:

- Nasal ointment: There are insufficient data to establish that product is safe and effective as part of an intervention program to prevent autoinfection of high-risk patients from their own nasal colonization with S. aureus; should not be used for general prophylaxis of any infection in any patient population; >90% of patients had eradication of nasal colonization within 2 to 4 days after therapy was completed; ~30% recolonization within 4 weeks of therapy was reported in one study.

- Topical ointment: Should not be used with intravenous (IV) cannulae or at central IV sites because of the potential to promote fungal infections and antimicrobial resistance.

Warnings: Additional Pediatric Considerations

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).

Metabolism/Transport Effects

None known.

Drug Interactions

There are no known significant interactions.

Pregnancy Considerations

Systemic absorption following topical application is minimal.

Breastfeeding Considerations

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.

Mechanism of Action

Binds to bacterial isoleucyl transfer-RNA synthetase resulting in the inhibition of protein synthesis

Pharmacokinetics

Absorption:

Topical ointment and cream: Penetrates outer layers of skin; systemic absorption minimal through intact skin

Intranasal: Adults: ~3%; Neonates and premature infants: Absorption may be significant

Protein binding: >97%

Metabolism: Rapidly metabolized to monic acid (inactive)

Half-life: 17 to 36 minutes

Excretion: Urine (as monic acid [inactive])

Pricing: US

Cream (Mupirocin Calcium External)

2% (per gram): $1.81 - $16.37

Kit (Centany AT External)

2% (per each): $393.19

Ointment (Centany External)

2% (per gram): $13.11

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.

Brand Names: International
  • Bacidal (TH);
  • Bacron (BD);
  • Bactex (TH);
  • Bactocin (BR, PH);
  • Bactoderm (ID, IL);
  • Bactokill (BD);
  • Bactreat (PH);
  • Bactrobaan (DE);
  • Bactroban (AE, AR, AT, AU, BB, BD, BE, BF, BG, BH, BJ, BM, BR, BS, BZ, CH, CI, CL, CN, CY, CZ, DK, EG, ES, ET, FI, FR, GB, GH, GM, GN, GR, GY, HK, HR, HU, ID, IE, IL, IN, IQ, IR, IS, IT, JM, JO, JP, KE, KR, KW, LB, LR, LU, LY, MA, ML, MR, MU, MW, MX, MY, NE, NG, NL, NO, NZ, OM, PH, PK, PL, PR, PT, PY, QA, RU, SA, SC, SD, SE, SG, SI, SK, SL, SN, SR, SY, TH, TN, TR, TT, TZ, UA, UG, UY, VE, VN, YE, ZA, ZM, ZW);
  • Bactrocin (LK);
  • Banbact (TH);
  • Banogon (ZA);
  • Bantix (CN, PY);
  • Betrion (HR);
  • Dermatech Bantix (CO);
  • Dermocin (ZW);
  • Dermucor S (CR, DO, GT, HN, NI, PA, SV);
  • Esroban (KR);
  • Foskina (PH);
  • Infecto Pyoderm (DE);
  • Macroban (TH);
  • Mertus (ID);
  • Mupiban (LK);
  • Mupicin (PH);
  • Mupider (NZ, SG);
  • Mupiderm (FR);
  • Mupiral (EC);
  • Mupirax (EG);
  • Mupiroban (KR);
  • MupiroNasal (BG);
  • Mupirox (AR, PE);
  • Mupirox Nasal (AR);
  • Muporin (TH);
  • Muprin (HK, ID, LK, MY);
  • Muropa (HK);
  • Nuban (ZA);
  • Pibaksin (ID, LK);
  • Plasimmine (ES);
  • Sinpebac (MX);
  • Skinroban (EG);
  • Spectroderm (PE);
  • Supirocin (MY, SG, TH, ZW);
  • Systop (BD);
  • Tapocin (BD);
  • Turixin (DE);
  • Vidox (UY)


For country code abbreviations (show table)
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