mupirocin and Eczema

Staphylococcus aureus has a peculiar ability to colonize the skin of patients with eczema and atopic dermatitis (AD), and is consistently found in eczematous skin lesions in these patients. A correlation between the severity of the eczema and colonization with S. aureus has been demonstrated, and it has been determined that bacterial colonization is an important factor aggravating skin lesions. Patients colonized with S. aureus have been treated with antibiotics in several open and double-blind placebo-controlled studies, with conflicting results.. To investigate the colonizing features of S. aureus in the lesional and nonlesional skin of patients with eczema and AD in China and to compare the therapeutic effect of mupirocin plus hydrocortisone butyrate with vehicle ointment plus hydrocortisone butyrate.. A multicentre, double-blind randomized trial was conducted. Eczema Area and Severity Index (EASI) scores were evaluated before the start of the trial and on the 7th, 14th and 28th day of treatment. Swabs for bacterial isolation were taken from lesional skin before the start of the trial and on the 7th, 14th and 28th day of treatment, and from nonlesional skin only before the start of the trial. A combination topical therapy with mupirocin plus hydrocortisone butyrate ointment was used in the experimental group, with vehicle ointment plus hydrocortisone butyrate ointment as a control.. Of 327 patients enrolled in the study, 208 had eczema and 119 had AD. Bacteria were isolated from 70.2% of lesional and 32.7% of nonlesional skin samples from patients with eczema, of which S. aureus accounted for 47.3% and 27.9%, respectively. Bacteria were isolated from 74.8% of lesional and 34.5% of nonlesional skin samples from patients with AD, of which S. aureus accounted for 79.8% and 80.5%, respectively. The colonization density of S. aureus was markedly higher in lesional than in nonlesional skin, both in patients with eczema and with AD (P < 0.01, P < 0.05), and was positively correlated with lesion severity. Considering the EASI scores before and after treatment and the final effective rate, good therapeutic effects were obtained in both the combination experimental groups and the control groups (P < 0.01), and there were no differences in the global therapeutic effect between the two groups in patients with eczema and with AD (P > 0.05). However, in patients with eczema with a clinical score of > 8 or in patients with AD with a clinical score of > 7, the therapeutic effect in the experimental groups was superior to that in the control groups (P < 0.05) on the 7th day of treatment. There were no differences between the two groups on the 14th and 28th days of treatment (P > 0.05). Following the improvement of symptoms and signs of eczema and AD, the positive rates of bacteria and S. aureus were reduced on the 7th day of treatment.. This study confirmed that lesional skin of patients with eczema and AD was more frequently colonized with S. aureus than was nonlesional skin. The more severe the eczema, the higher the colonization rate of S. aureus, and S. aureus was also more often present in lesional and nonlesional skin in patients with AD than in those with eczema. Staphylococcus aureus infection is related to the pathogenesis of eczema and AD. An antibiotic-corticosteroid combination and corticosteroid alone both gave good therapeutic effect in eczema and in AD, and both reduced colonization by S. aureus. Early combined topical therapy is beneficial to patients with moderate to severe eczema and AD, and it is unnecessary to use antibiotics at later stages of disease or in mild eczema or AD.

Topics: Adolescent; Adult; Aged; Anti-Bacterial Agents; Anti-Inflammatory Agents; Child; Child, Preschool; Dermatitis, Atopic; Dermatologic Agents; Double-Blind Method; Drug Therapy, Combination; Eczema; Female; Humans; Hydrocortisone; Male; Middle Aged; Mupirocin; Severity of Illness Index; Staphylococcal Skin Infections; Staphylococcus aureus; Treatment Outcome

The efficacy and safety of mupirocin calcium cream were compared with those of oral cephalexin in the treatment of secondarily infected eczema. In this multicentre, double-blind, double-dummy study, 159 patients with secondarily infected eczema (suitable for treatment with topical antimicrobials) and a total skin infection rating scale score of 8 or more were randomized to receive either topical mupirocin cream three times daily or oral cephalexin, 250 mg four times daily, for 10 days (intent-to-treat group). Clinical success (per-protocol group), defined in part as a patient with a response of improvement in the skin infection rating scale, was similar in the two groups: 89% for mupirocin (n = 44) and 82% for cephalexin (n = 38) [P = 0.29; 95% confidence interval (-8.4%, 22.5%)]. Bacteriological success (intent-to-treat group), defined as a patient with a response of eradication, improvement or colonization of bacteria at the end of therapy, however, was significantly higher for mupirocin [50% and 28% in the mupirocin (n = 48) and cephalexin (n = 47) groups, respectively; P=0.005]. Mupirocin cream was as well tolerated as cephalexin; 9% and 13% of patients reported adverse events related or possibly related to study medication in the mupirocin and cephalexin groups, respectively. The most common adverse events overall were diarrhoea and nausea. Mupirocin cream applied three times daily is as effective clinically and superior bacteriologically compared with oral cephalexin given four times daily in the treatment of secondarily infected eczema of limited depth and severity. Mupirocin cream is as well tolerated as oral cephalexin, and more patients prefer the topical regimen, which should improve patient compliance.

Topics: Administration, Cutaneous; Administration, Oral; Adult; Anti-Bacterial Agents; Cephalexin; Cephalosporins; Diarrhea; Double-Blind Method; Drug Administration Schedule; Eczema; Female; Humans; Male; Middle Aged; Mupirocin; Ointments; Opportunistic Infections; Patient Satisfaction; Skin Diseases, Bacterial

One hundred fifty-three strains of Staphylococcus aureus recovered from infected eczema frequently demonstrated resistance to multiple antibiotics. Penicillin and ampicillin resistance was extremely frequent (88%), methicillin resistance was found in nearly 14% of strains, and erythromycin and tetracycline resistance was present in 16%. S. aureus strains were uniformly sensitive to vancomycin, mupirocin, and cephalosporins. Experimental infections in human volunteers showed topical therapy with 2% mupirocin was more effective than oral erythromycin in suppression of both S. aureus and Streptococcus pyogenes.

Topics: Administration, Topical; Anti-Bacterial Agents; Drug Resistance, Microbial; Eczema; Erythromycin; Fatty Acids; Humans; Microbial Sensitivity Tests; Multicenter Studies as Topic; Mupirocin; Random Allocation; Staphylococcal Skin Infections; Staphylococcus aureus; Streptococcal Infections

Ninety-eight patients suffering from skin and soft tissue infections in the Côte d'Ivoire were treated topically with a new antibiotic, mupirocine, or with placebo in a double-blind study. Patients were allocated at random to receive one or other treatment, applying the ointment, supplied in identical tubes and of similar colour base, to the lesions 3 times a day for 5 days. Overall evaluation of clinical response to treatment showed that the results with mupirocine were significantly superior to those with placebo. No unwanted effects of treatment were observed in either treatment group.

Topics: Administration, Topical; Adult; Aged; Anti-Bacterial Agents; Bacterial Infections; Clinical Trials as Topic; Double-Blind Method; Eczema; Fatty Acids; Female; Humans; Male; Middle Aged; Mupirocin; Random Allocation; Skin Diseases, Infectious

Topics: Anti-Bacterial Agents; Child; Child, Preschool; Clinical Trials as Topic; Eczema; Fatty Acids; Female; Humans; Impetigo; Infant; Male; Mupirocin; Pyoderma; Skin Ulcer

The 'soak and smear' regimen is a highly effective method for localised topical therapy employed by dermatologists for widespread inflammatory skin conditions. The regimen involves application of topical medication under occlusion after soaking in water. Complications from this treatment method are rare. We present a case of multiple, generalised methicillin-resistant Staphylococcus aureus (MRSA)-positive furuncles arising in a patient as an unexpected consequence of therapy. The case highlights an unanticipated risk of a commonly employed treatment amid an epidemic of MRSA in the community.

Topics: Aged; Anti-Bacterial Agents; Chlorhexidine; Clobetasol; Diagnosis, Differential; Doxycycline; Eczema; Furunculosis; Glucocorticoids; Humans; Male; Methicillin-Resistant Staphylococcus aureus; Mupirocin; Rifampin; Staphylococcal Infections; Staphylococcus aureus; Treatment Outcome; Water

Staphylococcus aureus strains resistant to mupirocin (MIC > 4000 mg l-1) were recovered from children and staff at a school for children with eczema and/or asthma or cystic fibrosis after mupirocin had been used to treat eczematous lesions. At least three distinct strains of S. aureus were involved and resistance was shown to be due in most isolates to a transmissible plasmid. The need for monitoring the extended use of this valuable antibiotic is emphasized.

Topics: Adolescent; Asthma; Bacteriophage Typing; Carrier State; Child; Cystic Fibrosis; Drug Resistance, Microbial; Eczema; Female; Humans; Male; Mupirocin; Plasmids; Schools; Staphylococcal Infections; Staphylococcus aureus; Tetracycline

Topics: Adult; Betamethasone; Breast Diseases; Breast Feeding; Clinical Protocols; Consultants; Eczema; Female; Humans; Mupirocin; Nipples