Dosing and uses of Bactroban, Bactroban Nasal (mupirocin)
Adult dosage forms and strengths
cream/topical ointment
- 2%
nasal ointment
- 2%
Impetigo
Apply 2% ointment to affected area q8hr
If no response in 3-5 days, reevaluate
Secondary Skin Infection
Apply cream to affected area q8hr x10 days
If no response in 3-5 days, reevaluate
Elimination of MRSA Colonization
Intranasal: Apply 1/2 tube in nostril q12hr x5 days
Pediatric dosage forms and strengths
cream/topical ointment
- 2%
nasal ointment
- 2%
Impetigo
>2 months: Apply 2% ointment to affected area q8hr
If no response in 3-5 days, reevaluate
Secondary Skin Infection
>3 months: Apply cream to affected area q8hr x10 days
If no response in 3-5 days, reevaluate
Elimination of MRSA Colonization
>12 years (intranasal): Apply 1/2 tube in nostril q12hr x5 days
Bactroban, Bactroban Nasal (mupirocin) adverse (side) effects
1-10%
Headache (1.7%)
Nausea (1.7%)
Burning (1-3%)
Stinging (1-3%)
Pain (1-3%)
Pruritus (1-3%)
Rash (1-3%)
Cellulitis (1%)
Dry skin (1%)
Erythema (1%)
Incr exudate (1%)
Pain or bleeding secondary to eczema (1%)
Secondary wound infection (1%)
Swelling (1%)
Tenderness (1%)
Urticaria (1%)
Frequency not defined
Abdominal pain
Dizziness
Ulcerative stomatitis
Warnings
Contraindications
Hypersensitivity
Cautions
Anaphylaxis, urticaria, angioedema, and generalized rash reported
Manufacturer cautions against use of mupirocin ointment in burn patients, particularly those with extensive burns, since potentially toxic amounts of polyethylene glycol (PEG) contained in the vehicle may be absorbed percutaneously
Avoid contact with eyes; in case of accidental contact, rinse well with water
Discontinue use in event of sensitization or severe local irritation from ointment
Clostridium difficile-associated diarrhea (CDAD) reported with use; if CDAD suspected or confirmed, discontinue ongoing antibacterial drug use not directed against C. difficile; institute appropriate fluid and electrolyte management, protein supplementation, antibacterial treatment of C. difficile, and surgical evaluation, as clinically indicated
Prolonged use may result in overgrowth of nonsusceptible organisms, including fungi
Not formulated for use on mucosal surfaces; intranasal use has been associated with isolated reports of stinging and drying
Not for use in conditions where absorption of large quantities of polyethylene glycol possible, especially if there is evidence of moderate or severe renal impairment; polyethylene glycol can be absorbed from open wounds and damaged skin and is excreted by the kidneys
Ointment should not be used with intravenous cannulae or at central intravenous sites because of the potential to promote fungal infections and antimicrobial resistance
Pregnancy and lactation
Pregnancy category: B
Lactation: Not known if distributed into milk; recommended that nursing be temporarily discontinued during therapy
Pregnancy categories
A: Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.
B: May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk.
C: Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done.
D: Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk.
X: Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist.
NA: Information not available.
Pharmacology of Bactroban, Bactroban Nasal (mupirocin)
Mechanism of action
Bactericidal; inhibits protein synthesis in susceptible bacteria by reversibly binding to bacterial isoleucine-tRNA ligase (isoleucyl-tRNA synthetase), the enzyme that catalyzes the formation of isoleucyl-tRNA from isoleucine and tRNA
Absorption
<0.3%
Distribution
Protein bound: 95-97% in vitro
Metabolism
Enzymes present within skin may partially inactivate mupirocin by metabolizing drug to monic acid
Elimination
Excretion: Urinary concentrations range from undetectable to 10.03 mcg/mL in adults and from undetectable to 1.3 mcg/mL in children
