Mupirocin

Mupirocin is an antibiotic that is often used to treat skin infections. It is a powerful antibacterial agent and is usually used topically, directly on the skin, to treat a variety of infections caused by bacteria that are sensitive to it.

The drug is available in different forms, including ointment, cream or spray. It is effective against a wide range of bacteria, including many types of staphylococci (including methicillin-resistant staphylococci known as MRSA), streptococci and other Gram-positive bacteria.

The main indications for the use of mupirocin include the treatment of:

1. Pyoderma (purulent skin infections) such as boils, furuncles, impetigo and cellulitis.
2. Infections of wounds, burns, abrasions and other skin injuries.
3. Carriers of MRSA (methicillin-resistant Staphylococcus aureus) on the skin or in the nose.

The drug is usually well tolerated and side effects are rare. However, in some cases, skin irritation or an allergic reaction may occur. It is important to use mupirocin only as prescribed by your doctor and in accordance with his recommendations.

Indications Mupirocin

1. Boils and carbuncles: The drug may be used to treat purulent infections of hair follicles (boils) and their associations (carbuncles).
2. Impetigo: It is a superficial infectious skin disease that is usually caused by staphylococcal or streptococcal bacteria.
3. Cellulitis: An infectious disease of the skin and soft tissues characterized by inflammation and swelling.
4. Wounds, burns, abrasions: Mupirocin may be used to treat infected wounds, burns, abrasions and other skin injuries.
5. MRSA carriers: Methicillin-resistant Staphylococcus aureus (MRSA) can cause skin and soft tissue infections. The drug can be used to treat infected areas of the skin or to eliminate MRSA from the nasopharynx in carriers.
6. Prevention of postoperative infections: In some cases, Mupirocin may be used to prevent infections after surgery, especially in skin or nasopharyngeal surgeries.

Release form

1. Ointment for external use: Usually contains 2% of the active ingredient mupirocin. The ointment is applied directly to the affected skin or used to treat the nasal passages in MRSA carriers.
2. Cream for external use: Also contains 2% mupirocin and is used similarly to an ointment to treat skin infections. Creams may be preferred for treating some conditions because of their consistency and ease of application.
3. Nasal ointment: Specially formulated for use in the nasal passages to treat or prevent MRSA carriage. The concentration of mupirocin in nasal ointment is also 2%.

Pharmacodynamics

1. Mechanism of Action:

   • Mupirocin acts by inhibiting isoleucyl-tRNA synthetase isomerase, a key enzyme in protein biosynthesis in bacteria. This leads to disruption of bacterial protein synthesis and ultimately the death of the bacterial cell.

2. Scope:

   • The drug has activity against a wide range of bacteria, including many strains of Staphylococcus aureus (including methicillin-resistant strains) and Streptococcus pyogenes.

• Mupirocin is active against a variety of bacterial species including, but not limited to, the following:
  • Streptococcus pneumoniae: However, mupirocin is not the treatment of choice for infections caused by this organism.
  • Streptococcus agalactiae: Also known as group B streptococcus.
  • Streptococcusanginosus group: Including Streptococcus anginosus, Streptococcus intermedius and Streptococcus constellatus.

1. Developing Resilience:

   • Despite its high efficacy, resistance to mupirocin develops rather slowly due to its unique mechanism of action.

2. Application:

   • The drug is commonly used to treat skin infections such as impetigo (pyoderma) and infected wounds. It can also be used in nasal colonizations of Staphylococcus aureus.

3. Topical application:

   • The drug is available for topical application as an ointment, cream or nasal ointment.

4. Minimal systemic absorption:

   • Because mupirocin is virtually unabsorbed through the skin, it is generally well tolerated and has minimal systemic side effects.

Pharmacokinetics

1. Absorption: When applied externally, the drug is practically not absorbed through the skin. It remains on the skin surface and locally exerts its antibacterial effect.
2. Distribution: After topical application of mupirocin, it remains in the tissues and is not distributed in the systemic bloodstream in significant amounts.
3. Metabolism: The drug is almost not metabolized in the body. It remains in unchanged form and has its antibacterial activity.
4. Excretion: After discontinuation of mupirocin, its excretion from the body occurs mainly through the kidneys in unchanged form.
5. Half-life: The half-life of the drug when administered topically is small and has no clinical significance.
6. Time of action: Mupirocin stays on the skin for a long time, providing long-lasting antibacterial action.

Dosing and administration

Ointment or cream for external use (2%)

• Adults and children: A small amount of ointment or cream is applied to the affected area of the skin three times a day. The course of treatment is usually 7 to 10 days, depending on the doctor's recommendations and the response to treatment.
• Application: Before applying the drug, the affected area should be thoroughly cleaned and dried. The ointment or cream is applied in a thin layer. After application, sterile gauze or bandage may be used, unless otherwise recommended by a physician.
• Special instructions: Avoid contact of the drug with eyes, mucous membranes of the mouth or nose. If the drug accidentally gets into these areas, they should be rinsed thoroughly with plenty of water.

Nasal ointment (2%)

• Adults and children over 12 years of age: A small amount of nasal ointment is applied to the inner surface of each nostril twice daily (morning and evening) for 5 days.
• Application: A cotton swab or a clean finger can be used to apply the ointment. After applying the ointment in the nose, it is recommended to lightly massage the wings of the nose to ensure even distribution of the drug.
• Special instructions: The drug is intended for nasal application only. Avoid contact with the eyes.

General recommendations

• When using the product, it is important to observe hand hygiene before and after using the product.
• If symptoms do not improve within a few days of starting Mupirocin or the condition worsens, you should contact your doctor.
• Do not use the drug for longer than the recommended course of treatment to avoid the development of bacterial resistance to the antibiotic.

Use Mupirocin during pregnancy

Regarding its use during pregnancy, although topical application of mupirocin to the skin is generally considered safe, it is always advisable to consult a doctor before using any medication, especially during pregnancy.

Even though the systemic absorption of mupirocin when applied topically is low, it is still important to discuss its use with your doctor to make sure that the planned benefits of treatment outweigh the potential risks to you and your baby.

Contraindications

1. Hypersensitivity: Patients with known hypersensitivity to the drug or other components of the drug should not use it because of the risk of allergic reactions.
2. Systemic infections: Mupirocin is intended for topical use and is not recommended for the treatment of systemic infections or infections that spread beyond the skin. In such cases, systemic antibacterial treatment is required.
3. Pregnancy and breastfeeding: There are no sufficient data on the safety of the drug during pregnancy and breastfeeding. The use of mupirocin during these periods should be cautious and the decision on its use should be made by a physician.
4. Children: The safety and efficacy of mupirocin in children under 3 months of age have not been established. For this age group, it is recommended to consult a physician before use.
5. Caution when used near eyes and mucous membranes: It is not recommended to apply the product in the area of eyes and mucous membranes, as it may cause irritation.

Side effects Mupirocin

1. Skin Reactions: Skin irritation, redness, itching, or burning may occur at the site of application of mupirocin ointment or cream. Rarely, contact dermatitis may develop.
2. Allergic reactions: Allergic reactions such as urticaria (hives), angioedema (Quincke's edema) or allergic contact dermatitis may occur in isolated cases.
3. Systemic reactions: Systemic allergic reactions such as allergic reaction in the form of asthma, respiratory disturbances or anaphylactic shock may occur. However, such reactions are extremely rare.
4. Rare reactions: In rare cases, bleeding or exacerbation of pre-existing bleeding may be noted. Temporary worsening of psoriasis (if this disease is present) may also occur.

Overdose

Information on mupirocin overdose (when applied topically) is limited. Since the drug is a topical antibiotic, the likelihood of systemic absorption and development of overdose is low. However, in theory, undesirable effects may occur when administered in excess of the recommended dose.

If signs of overdose do occur (e.g. Skin irritation, itching, redness, swelling), immediately flush the affected area with water and seek medical attention.

Interactions with other drugs

1. Antiseptics and disinfectants: Applying antiseptics and disinfectants to the same area of skin where the medicine is applied may reduce its effectiveness. This is because antiseptics can kill bacteria before mupirocin can take effect.
2. Hormonal creams and ointments: Applying hormonal creams and ointments to the same area of skin where the drug is used may affect wound healing and inflammation. This should be discussed with your doctor as additional precautions may be necessary.
3. Other topical antibiotics: Applying other topical antibiotics to the same area of skin may cause competition for resources and potentially reduce the effectiveness of mupirocin. If you need to use more than one topical antibiotic, discuss this with your doctor.
4. Drugs that increase local bleeding: It is possible that some drugs that increase local bleeding may increase the risk of spreading infection and reduce the effectiveness of the drug. This should also be discussed with your doctor.

Storage conditions

1. Temperature: Mupirocin should usually be stored at room temperature, 15 to 25 degrees Celsius (59 to 77 degrees Fahrenheit).
2. Dryness: The drug should be stored in a dry place to avoid moisture, which may affect its stability and efficacy.
3. Light: The product should be stored in a dark container or in a place protected from direct sunlight. This helps prevent the active ingredients from decomposing when exposed to light.
4. Children: Keep Mupirocin out of the reach of children to prevent accidental use.
5. Manufacturer's instructions: Always follow the directions on the package or in the instructions for use provided by the drug manufacturer.