Bactroban

Topical Antibacterial Agents, Other
Topical Nasal Anti-infectives

Apply to affected area. Treated area may be covered with sterile gauze dressing if desired.
Avoid contact with the eyes and mucosal surfaces.
Topical cream and ointment products are not FDA-approved for nasal use.

Nasal Administration
Apply ointment inside the nose.
After application, close the nostrils by pressing together and releasing the sides of the nose repetitively for approximately 1 minute. This will spread the ointment throughout the nares.
Avoid contact with the eyes.
Do not apply concurrently with any other intranasal product.

angioedema / Rapid / Incidence not known
anaphylactoid reactions / Rapid / Incidence not known
C. difficile-associated diarrhea / Delayed / Incidence not known

erythema / Early / 0-1.0
contact dermatitis / Delayed / 0-1.0
stomatitis / Delayed / 0-1.0
blepharitis / Early / 0-1.0
superinfection / Delayed / Incidence not known
pseudomembranous colitis / Delayed / Incidence not known

rash / Early / 1.0-10.0
headache / Early / 1.7-9.0
rhinitis / Early / 6.0-6.0
nausea / Early / 0-4.9
pharyngitis / Delayed / 4.0-4.0
skin irritation / Early / 0-3.6
dysgeusia / Early / 3.0-3.0
nasal irritation / Early / 2.0-2.0
cough / Delayed / 2.0-2.0
xerosis / Delayed / 0-1.0
epistaxis / Delayed / 0-1.0
xerostomia / Early / 0-1.0
otalgia / Early / 0-1.0
diarrhea / Early / 0-1.0
pruritus / Rapid / Incidence not known
urticaria / Rapid / Incidence not known
abdominal pain / Early / Incidence not known
dizziness / Early / Incidence not known
infection / Delayed / Incidence not known

Bactroban, Centany, Centany AT

Rx

Unique topical antibiotic produced from Pseudomonas fluorescens; active against gram positive organisms like S. aureus and Strept. pyogenes; used for skin infections like impetigo; also in an intranasal ointment to eradicate nasal colonization of MRSA.

Apply a small amount to the affected area(s) 3 times daily. The area(s) may be covered with a sterile gauze dressing. Therapy is usually continued for 1 to 2 weeks. If a response is not evident within 3 to 5 days, the infection should be reevaluated. Studies evaluating use of mupirocin for the treatment of impetigo have found the ointment produces similar cure rates to oral erythromycin.

Apply a small amount to the affected area(s) 3 times daily for 10 days. If a response is not evident within 3 to 5 days, the infection should be reevaluated.

Apply a small amount (500 mg) into each nare 2 times daily for 5 to 10 days.

Apply a small amount (500 mg) into each nare 2 times daily for 5 to 10 days.

Apply a small amount (500 mg) into each nare 2 times daily for 5 to 10 days.

Apply a small amount to the affected area(s) 3 times daily. Clinical practice guidelines support the use of mupirocin for mild cases with localized disease.

Apply a small amount to the affected area(s) 2 to 3 times daily for 1 to 2 weeks. Topical mupirocin ointment has similar or superior efficacy when compared with systemic antibiotics (i.e., erythromycin, ampicillin, flucloxacillin) for secondary skin infections, including infected eczema.

Apply a small amount to the affected area(s) 3 times daily for 5 to 14 days. Topical mupirocin ointment has similar or superior efficacy when compared with systemic antibiotics (i.e., ampicillin, cloxacillin, erythromycin) for primary skin infections, including folliculitis.

Apply a small amount to each nare topically twice daily for up to 5 days pre-operatively. Use in combination with chlorhexidine baths once daily.

†Indicates off-label use

No dosage adjustment needed.

No dosage adjustment needed.

There are no drug interactions associated with Mupirocin products.

Bactroban/Centany/Centany AT/Mupirocin Topical Ointment: 2%
Bactroban/Mupirocin/Mupirocin Calcium Topical Cream: 2%

Intranasal, 5 days of twice daily therapy; Topical, maximum dosage information is not available.

Intranasal, 5 days of twice daily therapy; Topical, maximum dosage information is not available.

Intranasal, 5 days of twice daily therapy; Topical, maximum dosage information is not available.

12 years: Intranasal, 5 days of twice daily therapy; Topical, maximum dosage information is not available.
1 to 11 years: Maximum dosage information is not available for topical ointment or cream. Safety and efficacy not established for intranasal ointment; however, intranasal ointment has been used off-label.

3 months and older: Maximum dosage information is not available for topical ointment or cream. Safety and efficacy not established for intranasal ointment; however, intranasal ointment has been used off-label.
2 months: Maximum dosage information is not available for topical ointment. Safety and efficacy not established for topical cream or intranasal ointment; however, intranasal ointment has been used off label.
younger than 2 months: Safety and efficacy not established; however, topical and intranasal ointment have been used off-label.
 

Safety and efficacy not established; however, topical ointment has been used off-label.

Mupirocin is bacteriostatic at low concentrations and bactericidal at high concentrations. Bacterial protein and RNA synthesis are inhibited when mupirocin reversibly binds to bacterial isoleucyl-tRNA synthetase. This enzyme normally promotes the conversion of isoleucine and tRNA to isoleucyl-tRNA. The epoxide side chain of mupirocin is similar to isoleucine and competes with it for binding sites on the synthetase enzyme. The cellular concentration of isoleucyl-tRNA becomes depleted, subsequently inhibiting bacterial protein and RNA synthesis. Unlike many other antibiotics, mupirocin has little effect on bacterial DNA synthesis and cell wall peptidoglycan formation.

Mupirocin is administered topically to the skin or the nares. Once in systemic circulation, it is rapidly metabolized to inactive monic acid and is excreted via the kidneys. The elimination half-life is 20—40 minutes for mupirocin and 30—80 minutes for monic acid.

Percutaneous absorption through intact skin is minimal in both pediatric and adult patients. Following topical administration, > 97% of the drug is bound to protein. Polyethylene glycol (PEG), the vehicle used for the ointment, can be absorbed from open or damaged skin and may cause renal failure.

Intranasal Route
In adults, systemic absorption of intranasally applied mupirocin ointment is minimal. One study suggested 3.3% (range: 1.2—5.1%) of an applied dose may be absorbed from the nasal mucosa of adults. Pharmacokinetic studies have not been conducted in pediatric patients < 12 years of age.

There are insufficient human data to establish a drug-associated risk with mupirocin use during pregnancy. Systemic absorption of mupirocin through intact skin is minimal after topical administration of mupirocin. No developmental toxicity was observed in rats or rabbits given mupirocin subcutaneously at doses 11 and 22 times the human topical dose based on calculations of dose divided by the entire body surface area.

It is not known whether mupirocin is present in human breast milk, has effects on the breast-fed child, or has effects on milk production. However, breast-feeding is not expected to result in exposure of the child to mupirocin due to the minimal systemic absorption of mupirocin after topical administration. Consider the benefits of breast-feeding along with the mother's clinical need for mupirocin and any potential adverse effects on the breast-fed child from mupirocin or the underlying maternal condition. To minimize oral exposure of the drug to the breast-feeding child, thoroughly wash a breast and/or nipple being treated with mupirocin prior to breast-feeding.