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standards of non-Merck sources.
Medication Safety Issues
Sound-alike/look-alike issues:
Bactroban® may be confused with bacitracin, baclofen, Bactrim™
Pronunciation
(myoo PEER oh sin)
U.S. Brand Names
Index Terms
Generic Available
Yes: Topical ointment
Canadian Brand Names
Pharmacologic Category
Pharmacologic Category Synonyms
Use: Labeled Indications
Intranasal: Eradication of nasal colonization with MRSA in adult patients and healthcare workers
Topical: Treatment of impetigo or secondary infected traumatic skin lesions due to S. aureus and S. pyogenes
Use: Unlabeled/Investigational
Intranasal: Surgical prophylaxis to prevent wound infections
Pregnancy Risk Factor
B
Pregnancy Considerations
Teratogenic effects were not observed in animal studies. There are no adequate and well-controlled studies in pregnant women; use during pregnancy only if clearly needed.
Lactation
Excretion in breast milk unknown/use caution
Contraindications
Hypersensitivity to mupirocin or any component of the formulation
Warnings/Precautions
Concerns related to adverse effects:
• Irritation: If skin 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: Use with caution in patients with renal impairment.
Special populations:
• Pediatrics: Safety and efficacy of the nasal product have not been established in children <12 years of age.
Dosage form specific issues:
• 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.
Other warnings/precautions:
• Appropriate use: For external use only; avoid contact with eyes. Not for treatment of pressure sores.
Adverse Reactions
Frequency not defined.
Central nervous system: Dizziness, headache
Dermatologic: Cellulitis, dermatitis, dry skin, erythema, hives, pruritus, rash, ulcerative stomatitis
Gastrointestinal: Abdominal pain, diarrhea, nausea, taste perversion, xerostomia
Local: Burning, edema, pain, stinging, tenderness
Ocular: Blepharitis
Otic: Ear pain
Respiratory: Cough, pharyngitis, rhinitis, upper respiratory tract congestion
Miscellaneous: Secondary wound infection
Drug Interactions
Typhoid Vaccine: Antibiotics may diminish the therapeutic effect of Typhoid Vaccine. Only the live attenuated Ty21a strain is affected. Risk D: Consider therapy modification
Mechanism of Action
Binds to bacterial isoleucyl transfer-RNA synthetase resulting in the inhibition of protein synthesis
Pharmacodynamics/Kinetics
Absorption: Topical: Penetrates outer layers of skin; systemic absorption minimal through intact skin
Metabolism: Skin: 3% to monic acid (inactive)
Excretion: Urine
Dosage
Intranasal: Children ?12 years and Adults: Eradication of nasal MRSA: Approximately one-half of the ointment from the single-use tube should be applied into one nostril and the other half into the other nostril twice daily for 5 days
Topical:
Children ?2 months and Adults: Impetigo: Ointment: Apply to affected area 3 times/day; re-evaluate after 3-5 days if no clinical response
Children ?3 months and Adults: Secondary skin infections: Cream: Apply to affected area 3 times/day for 10 days; re-evaluate after 3-5 days if no clinical response
Administration: Topical
Intranasal ointment: After application into nostrils, press sides of nose together and gently massage to spread ointment throughout the insides of the nostrils; discard tube after use
Topical cream, ointment: For external use only; area may be covered with gauze if desired
Patient Education
For external use only. Wash hands before and after application. Apply thin film over affected areas exactly as directed. Avoid getting in eyes. Report rash, persistent burning, stinging, swelling, itching, or pain. Contact prescriber if no improvement is seen in 3-5 days. Breast-feeding precaution: Consult prescriber if breast-feeding.
Geriatric Considerations
Not for treatment of pressure sores.
Dental Health: Effects on Dental Treatment
Key adverse event(s) related to dental treatment: Xerostomia (normal salivary flow resumes upon discontinuation) and taste perversion.
Dental Health: Vasoconstrictor/Local Anesthetic Precautions
No information available to require special precautions
Mental Health: Effects on Mental Status
None reported
Mental Health: Effects on Psychiatric Treatment
None reported
Nursing: Physical Assessment/Monitoring
Assess for effectiveness of therapy and symptoms of infection. Assess knowledge/teach patient appropriate application and use and adverse symptoms to report.
Dosage Forms
Excipient information presented when available (limited, particularly for generics); consult specific product labeling. [DSC] = Discontinued product
Note: Strength expressed as base
Cream, topical, as calcium:
Bactroban®: 2% (15 g, 30 g) [contains benzyl alcohol]
Ointment, intranasal, as calcium:
Bactroban® Nasal: 2% (1 g) [single-use tube]
Ointment, topical: 2% (0.9 g, 22 g)
Bactroban®: 2% (22 g) [contains polyethylene glycol]
Centany™: 2% (15 g) [DSC]
Pricing: U.S. (www.drugstore.com)
Cream (Bactroban)
2% (15): $56.37
2% (30): $83.64
Ointment (Bactroban)
2% (22): $69.99
Ointment (Mupirocin)
2% (22): $34.99
References
Blumer JL, Lemon E, O'Horo J, et al, “Changing Therapy for Skin and Soft Tissue Infections in Children: Have We Come Full Circle?” Pediatr Infect Dis J, 1987, 6(1):117-22.
Britton JW, Fajardo JE, and Krafte-Jacobs B, “Comparison of Mupirocin and Erythromycin in the Treatment of Impetigo,” J Pediatr, 1990, 117(5):827-9.
Goldfarb J, Crenshaw D, O'Horo J, et al, “Randomized Clinical Trial of Topical Mupirocin Versus Oral Erythromycin for Impetigo,” Antimicrob Agents Chemother, 1988, 32(12):1780-3.
Perl TM, Cullen JJ, Wenzel RP, et al, “Intranasal Mupirocin to Prevent Postoperative Staphylococcus aureus Infections,” N Engl J Med, 2002, 346(24):1871-7.
International Brand Names
Lexi-Comp.com
Last full review/revision September 2008
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