A double-blind, randomized, placebo-controlled clinical trial to evaluate the safety and efficacy of mupirocin calcium ointment for eliminating nasal carriage of Staphylococcus aureus among hospital personnel

Abstract

Sixty-eight health care workers were enrolled in a double-blind clinical trial and randomized to receive either mupirocin calcium ointment or placebo, intranasally bid for 5 days. Nasal cultures were taken immediately before starting treatment, 1 and 2 during treatment, at the end of treatment, 3 days later, weekly for 1-5 weeks and then monthly for 2-6 months after treatment. Mupirocin eliminated nasal carriage with Staphylococcus aureus in 58% of subjects within two days and 86.7% subjects by the end of therapy compared to 9.4% subjects at the end of treatment with placebo (P < 0.001). Post-treatment colonization rates of 43%, 56% and 67% were attained after 1 month, 2-4 and 6 months treatment with mupirocin respectively and recolonisation with the same strain of S. aureus that had been isolated before treatment was noted in 32%, 40% and 48%. No resistance to mupirocin developed and the drug was well tolerated. Mupirocin is safe and effective in suppressing nasal carriage of S. aureus.

Treatment of Staphylococcus aureus Colonization and Prophylaxis for Infection with Topical Intranasal Mupirocin: An Evidence-Based Review

“…Nine prospective trials evaluating mupirocin for eradication of nasal colonization with S. aureus fulfilled inclusion criteria [13,[20][21][22][23][24][25][26][27]. Four clinical trials that assessed the development of clinical infection as the primary outcome measure also evaluated clearance of nasal colonization [28][29][30][31].…”

“…Fernandez et al [24] conducted a DBRPCT that was designed similarly to that reported by Doebbeling et al [21]. Among 68 individuals randomized to receive either mupirocin or placebo, culture positivity rates were 13% and 91% immediately after treatment and 67% and 94% at 6 months after treatment, respectively.…”

Efficacy of a New Cream Formulation of Mupirocin: Comparison with Oral and Topical Agents in Experimental Skin Infections

“…1689, 1992). More recently, mupirocin as a 2% ointment in a soft white paraffin base has been shown to be highly effective in the elimination of nasal carriage of staphylococci, including methicillin-resistant S. aureus (9,17,18).…”

Genesis of Methicillin‐ResistantStaphylococcus aureus(MRSA), How Treatment of MRSA Infections Has Selected for Vancomycin‐ResistantEnterococcus faecium,and the Importance of Antibiotic Management and Infection Control

“…A convenient means to evaluate the impact of this in vivo antimicrobial exposure on S. aureus resistance would be to study the impact of exposure to antibiotics on MSSA in the anterior nares, a common reservoir for S. aureus [38]. In a though cephalothin was proven more stable in the presence of case-control study by Kluytmans et al [13], nasal carriage of the resistance mechanisms of S. aureus, the formulary commit-S. aureus was found to be a significant risk factor for the tees ascribed greater importance to the pharmacokinetic advandevelopment of sternotomy wound infection following cardiac tage of cefazolin over cephalothin due to three-times-daily dossurgery.…”