mupirocin and Skin-Diseases--Infectious

Mupirocin is a novel antibiotic, for topical use only, which is unrelated in chemical structure and mode of action to any known class of antibacterial agent. It is active against a wide range of Gram-positive bacteria, including staphylococci and most streptococci, and is moderately active against Gram-negative bacteria. Mupirocin 2% ointment applied 2 or 3 times daily has demonstrable efficacy for the treatment of both primary and secondary skin infections and compares favourably with other topical and systemic treatments. In clinical studies, both elimination of the bacterial pathogen and clinical cure or improvement has been usual in over 90% of patients. Up to 40% of the normal population carry Staphylococcus aureus in the anterior nares and this carriage rate is often increased in hospitalized patients and their attendants. The increasing incidence of multiply- and methicillin-resistant S. aureus (MRSA) has been associated with hospital outbreaks leading to considerable morbidity and disruption of hospital services. Intranasal 2% calcium mupirocin has been shown to be effective in the eradication of nasal carriage; in bacteriologically controlled studies elimination of S. aureus, including MRSA, was achieved in over 95% of subjects. The role of mupirocin in preventing staphylococcal infection is currently undergoing evaluation.

Topics: Administration, Topical; Bacterial Infections; Gram-Positive Bacteria; Humans; Mupirocin; Nasal Cavity; Skin Diseases, Infectious; Staphylococcal Infections

Topics: Administration, Topical; Animals; Anti-Bacterial Agents; Fatty Acids; Humans; Mupirocin; Pseudomonas fluorescens; Skin Diseases, Infectious; Staphylococcus; Streptococcus

Mupirocin (pseudomonic acid A) is a novel topical antibacterial agent which inhibits bacterial protein and RNA synthesis. It has excellent in vitro activity against staphylococci and most streptococci, but has less activity against other Gram-positive and most Gram-negative bacteria. Its rapid systemic metabolism means it will only be used topically which, combined with its novel chemical structure, should make cross-resistance less likely to occur than with other currently available topical antibacterial agents. Mupirocin 2% ointment administered 2 or 3 times daily has shown excellent efficacy in both primary and secondary superficial skin infections, usually with at least 80% of patients being clinically cured or markedly improved, and over 90% eradication of the bacterial pathogen involved. Efficacy in impetigo and, to a somewhat lesser extent, infected wounds has been particularly convincingly demonstrated, while in other secondary skin infections the clinical response seen with mupirocin was often similar to the high success rate of vehicle alone. Limited evidence suggests that mupirocin may be as effective as chlortetracycline, fusidic acid, neomycin and other antibacterial agents, but more controlled, comparative studies are needed. The evidence of efficacy against nasal carriage of Staphylococcus aureus, including methicillin-resistant forms, is encouraging and currently work is being undertaken to improve the acceptability of the vehicle for this use. Side effects are limited to local reactions (in less than 3% of patients) and are no more frequent than observed with the vehicle alone. Thus, mupirocin appears to be a useful addition to the agents available for the treatment of superficial primary skin infections, such as impetigo, although its precise place in therapy remains to be established.

Topics: Administration, Cutaneous; Anti-Bacterial Agents; Fatty Acids; Gram-Negative Bacteria; Gram-Positive Bacteria; Humans; Kinetics; Mupirocin; Skin Diseases, Infectious

Mupirocin is an investigational topical antibiotic used for treatment and prophylaxis of bacterial skin infections. Mupirocin differs from other antibiotics in its synthesis, structure, and mechanism of action. In vitro, mupirocin possesses antimicrobial activity against staphylococci, streptococci, Hemophilus influenzae, and Neisseria gonorrhoeae. Few studies comparing mupirocin to other topical antibiotics are available. Initial studies comparing mupirocin to inactive vehicle in the treatment of impetigo indicate an overall 92 percent pathogen eradication rate with active drug and 58 percent eradication rate with vehicle. Overall response to treatment of secondary skin infections was favorable in 91 percent of patients treated with mupirocin and 77 percent of those treated with vehicle. Although incidence is not greater than placebo, adverse effects have included pruritus, burning, dry skin, and erythema. Additional trials and clinical use should further help determine the role of mupirocin in the treatment of minor, primary, and secondary skin infections.

Topics: Anti-Bacterial Agents; Fatty Acids; Humans; Mupirocin; Skin Diseases, Infectious

A total of 413 eligible patients took part in an observer-blind randomised multicentre clinical trial in order to compare the clinical and bacteriological efficacy of mupirocin (Bactroban) ointment with sodium fusidate (Fucidin) ointment for treating superficial skin infections seen in general practice. Mupirocin was applied twice daily and sodium fusidate thrice daily for a period of 7 days. Both treatments were similarly effective with 97% patients treated with mupirocin and 93% patients treated with sodium fusidate responding. Mupirocin was significantly more effective in the treatment of acute primary skin infections and in the treatment of a subgroup of patients with impetigo (P less than 0.01). Of the organisms detected before treatment began, 93% were not found after treatment with mupirocin compared with 89% after treatment with sodium fusidate. Staphylococcus aureus and/or beta-haemolytic streptococci appeared to be eliminated in significantly more patients treated with mupirocin (96%) compared with those treated with sodium fusidate (88%), (P = 0.03). Both treatments were well tolerated.

Topics: Administration, Topical; Adolescent; Adult; Anti-Bacterial Agents; Bacteria; Child; Child, Preschool; Fatty Acids; Fusidic Acid; Humans; Infant; Middle Aged; Multicenter Studies as Topic; Mupirocin; Random Allocation; Skin Diseases, Infectious; Staphylococcus aureus; Streptococcus

The efficacy and side effects of topical mupirocin (Bactroban) and fusidic acid (Fucidin) ointment were compared in a double-blind, randomized trial in 70 patients who came to the Dermatologic Clinic of L'Enfant Jésus Hospital with primary or secondary (or both) skin infections. Thirty-five patients were treated with mupirocin and 35 patients were treated with fusidic acid three times a day for seven days. Clinical and bacteriologic assessments were conducted before and after treatment. The efficacy of mupirocin, in terms of resolution and improvement of clinical signs and symptoms of infection, as well as of the elimination of infecting organisms, was similar to that of fusidic acid. Of 34 patients (1 could not be evaluated) treated with mupirocin, a clinical cure was achieved in 18, and significant improvement was demonstrated in 15. Similarly, of 35 patients treated with fusidic acid, a clinical cure was achieved in 18 and improvement occurred in 15. Bacteriologic cure rates were 97% (30 of 31 patients evaluated) in the mupirocin-treated group, compared with 87% (27 of 31 patients evaluated) in the fusidic acid-treated group. No side effects were observed in either treatment group. Because topical 2% mupirocin has little or no potential for irritation, systemic side effects, or cross-resistance with other antibiotics, its efficacy is likely to make this new compound a useful agent for the treatment of superficial skin infections.

Topics: Administration, Topical; Anti-Bacterial Agents; Bacterial Infections; Drug Evaluation; Fatty Acids; Female; Fusidic Acid; Humans; Male; Mupirocin; Ointments; Random Allocation; Skin Diseases, Infectious

A double-blinded study was conducted to compare the effects of mupirocin and tetracycline ointments in the treatment of skin infections. 111 patients were available for clinical assessment, of which 53 were treated with mupirocin and 58 treated with tetracycline. Clinically, both groups were improved, and there was no significant difference. Bacteriological assessment however revealed a better response to mupirocin. Staphylococcus aureus and Streptococcus pyogenes were the most common organisms isolated. 99% of Staphylococci were sensitive to mupirocin compared with 61% to tetracycline and 29% to penicillin G. 57% of Group A beta haemolytic Streptococci were resistant to tetracycline compared to 14% to mupirocin. Gram-negative organisms were mostly resistant to both preparations. No side effects were observed in both treatment groups. This study suggests that mupirocin is a safe and effective topical preparation for treating most of our common skin infections.

Topics: Adolescent; Adult; Anti-Bacterial Agents; Bacterial Infections; Clinical Trials as Topic; Double-Blind Method; Fatty Acids; Female; Humans; Male; Mupirocin; Ointments; Random Allocation; Skin Diseases, Infectious; Tetracycline

Staphylococci and beta-haemolytic streptococci are usually responsible for causing common primary and secondary skin infections. Mupirocin (Bactroban, Eismycin; trademarks of Beecham Group plc), a new antibiotic unrelated to any other antibacterial agent and developed for topical use only, shows a high level of activity against these bacteria. In an open multicentre study the efficacy and safety of mupirocin (2% in a polyethylene glycol vehicle) was evaluated in 1,391 general practice patients with superficial skin infections. The most common skin infections treated were pyoderma (eg, impetigo, folliculitis) and secondarily infected skin lesions. Treatment consisted of application of the ointment three times daily for an average of nine days. A total of 1,304 patients were evaluable for post-treatment clinical assessment. At the end of the treatment 961 (73.7 per cent) patients were cured and in 293 (22.5 per cent) patients the symptoms of the infection had markedly improved. In total, 525 bacterial strains were isolated from the wounds of 445 patients, predominantly staphylococci (n = 344) and streptococci (n = 93). Local side effects such as burning, itching and reddening were observed in 39 (2.9 per cent) of 1,357 patients. No evidence of systemic toxicity or abnormal laboratory data was noted. Mupirocin 2% ointment proved to be effective and safe in the treatment of primary and secondary skin infections.

Topics: Anti-Bacterial Agents; Fatty Acids; Female; Humans; Male; Multicenter Studies as Topic; Mupirocin; Ointments; Skin Diseases, Infectious

Topics: Administration, Cutaneous; Anti-Bacterial Agents; Bacitracin; Clinical Trials as Topic; Double-Blind Method; Drug Combinations; Drug Therapy, Combination; Fatty Acids; Humans; Mupirocin; Neomycin; Polymyxin B; Polymyxins; Random Allocation; Skin Diseases, Infectious; Skin Ulcer; Staphylococcus

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

Sodium fusidate ointment and mupirocin ointment were compared in 354 patients with superficial skin sepsis. The ointments were applied 3-times daily, or once daily when covered by a dressing, and the response assessed after 6 to 8 days. Both preparations proved effective clinically with 86% of patients responding. There was no difference between the two preparations in cases of primary infection (85% to both ointments), including a sub-group with impetigo (sodium fusidate 88% and mupirocin 84%), or secondary infection (sodium fusidate 81% and mupirocin 89%). Sodium fusidate ointment (98%) was significantly better (p less than 0.05) than mupirocin (82%) in patients with other superficial infections. Both ointments were equally effective in cases where Gram-positive, Gram-negative or mixed Gram-positive/Gram-negative bacteria were isolated. Adverse effects were reported in 1.0% of patients using sodium fusidate ointment and in 7.4% of patients using mupirocin ointment. The majority of complaints concerned the greasiness of mupirocin ointment.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Anti-Bacterial Agents; Child; Child, Preschool; Fatty Acids; Female; Fusidic Acid; Humans; Impetigo; Infant; Male; Middle Aged; Mupirocin; Ointments; Skin Diseases, Infectious

Topics: Administration, Topical; Bacterial Infections; Clinical Trials as Topic; Fatty Acids; Humans; Mupirocin; Skin Diseases, Infectious

A trial was carried out in general practice in 200 patients presenting with skin infections to compare topical antibiotic treatment with mupirocin ointment with orally administered flucloxacillin or erythromycin. Patients were assigned at random to receive 4 to 10 days' treatment with either mupirocin applied 3-times daily or one of the oral antibiotics in the dosage normally used by the general practitioner for skin infections. The majority of infections were impetigo and infected wounds/lacerations; the main organisms isolated initially from 127 of the patients were either Staphylococcus aureus or beta-haemolytic Group A streptococci. Clinical response to mupirocin ointment (86% cured, 13% improved) was significantly better than that seen with erythromycin (47% cured, 26% improved) and similar to that with flucloxacillin (76% cured, 23% improved). Treatment outcome was not related to treatment duration with either the topical or oral preparations. Post-treatment samples from 76 patients showed that in the mupirocin group all the pathogens originally isolated were eliminated, including Gram-negative organisms.

Topics: Administration, Topical; Anti-Bacterial Agents; Child; Child, Preschool; Erythromycin; Fatty Acids; Female; Floxacillin; Humans; Infant; Male; Mupirocin; Random Allocation; Skin Diseases, Infectious; Staphylococcal Infections; Streptococcal Infections

Pseudomonic acid, a new wide-spectrum antimicrobial agent, was evaluated as a 2% formulation in a cream. Animal studies showed that this formulation was just capable of penetrating the skin. When administered parenterally to animals, pseudomonic acid was converted to inactive metabolites that were quickly eliminated from the body. When pseudomonic acid was applied as a cream to human skin, no sensitization was observed. In an open clinical study, sixty-eight patients with skin infections (mostly superficial conditions such as impetigo, infected eczema, folliculitis, or balanitis) applied pseudomonic acid cream three times a day for 5 days. In fifty patients the infections completely cleared within 2 days of the end of therapy, and considerable clinical improvement was noted in sixteen more. One patient stopped the treatment prematurely due to local burning pain, and one patient could not be evaluated clinically.

Topics: Administration, Topical; Adolescent; Animals; Anti-Bacterial Agents; Child, Preschool; Clinical Trials as Topic; Dogs; Double-Blind Method; Fatty Acids; Female; Humans; Male; Middle Aged; Mupirocin; Rats; Skin Absorption; Skin Diseases, Infectious

Chrysomycin A, a compound derived from marine microorganisms, proved to have a specific great in vitro inhibitory effect on methicillin-resistant

Topics: Aminoglycosides; Anti-Bacterial Agents; Humans; Methicillin-Resistant Staphylococcus aureus; Microbial Sensitivity Tests; Mupirocin; Skin Diseases, Infectious; Staphylococcal Infections

The in vivo efficacy of the novel polymeric guanidine AKACID Plus was evaluated in a guinea pig model of experimental skin infection with methicillin-resistant Staphylococcus aureus (MRSA). Topical application of AKACID Plus at concentrations of > or =0.5% was as effective as mupirocin 2% cream in the treatment of superficial skin infection with MRSA.

Topics: Animals; Anti-Bacterial Agents; Colony Count, Microbial; Dose-Response Relationship, Drug; Female; Guanidines; Guinea Pigs; Male; Methicillin Resistance; Mupirocin; Polymers; Skin; Skin Diseases, Infectious; Staphylococcal Infections

Topics: Administration, Cutaneous; Anti-Infective Agents; Child; Dermatitis, Atopic; Dermatologic Surgical Procedures; Diabetic Foot; Drug Resistance, Bacterial; Epidermolysis Bullosa; Humans; Impetigo; Mupirocin; Patient Compliance; Skin; Skin Diseases, Infectious

The microbicidal effect of mupirocin (Bactroban) was studied using an in vitro model of burn eschar in contact with this antimicrobial cream, to indicate its inhibiting action after 1, 2, 4, and 24 h. The microorganisms used were 20 isolates of Ps. aeruginosa, 20 isolates of MRSA, 10 isolates of Staph. epidermidis, 12 isolates of Enterobacteriaceae and eight isolates of Candida albicans. There was a marked effect on Gram-negative bacilli (< 0.1 per cent surviving) by 4 h, whereas on Gram-positive organisms its effect was slower, principally on MRSA with 2.2 per cent survivors by 24 h. The action on Candida was very slow initially, but after 24 h, the mupirocin's effect was marked (< 0.1 per cent survivors). The studies showed that mupirocin (a topical broad-spectrum antimicrobial agent) can be used in vitro against Gram-positive and Gram-negative bacteria and yeasts, which contaminate skin and mucosa. Further clinical experience is required before mupirocin can be used to treat colonized or infected wounds in burned patients.

Topics: Animals; Bacteria; Burns; Candida; Drug Evaluation, Preclinical; In Vitro Techniques; Microbial Sensitivity Tests; Mupirocin; Skin; Skin Diseases, Infectious; Swine

Mupirocin (2 percent) ointment is a unique topical agent recently developed for use in the treatment of superficial skin infections. It has shown excellent in vitro and in vivo activity against gram-positive staphylococci and streptococci, which are the predominant pathogens in most superficial skin infections, and against gram-negative Hemophilus influenzae and Neisseria gonorrhoeae. At present, mupirocin (2 percent) ointment has been approved for use in the treatment of impetigo, but an analysis of several recent clinical trials has also indicated the potential for mupirocin treatment of other primary and secondary skin infections. Furthermore, because mupirocin apparently has fewer adverse effects than systemic antibiotics, is less expensive, easier to administer, and less likely to induce antibiotic resistance, it should be considered as an alternative to oral agents in the antimicrobial therapy of a variety of primary and secondary skin disorders.

Topics: Administration, Oral; Administration, Topical; Anti-Bacterial Agents; Fatty Acids; Humans; Mupirocin; Ointments; Skin Diseases, Infectious

Topics: Anti-Bacterial Agents; Child, Preschool; Dermatitis, Atopic; Fatty Acids; Humans; Male; Mupirocin; Ointments; Penicillin Resistance; Skin Diseases, Infectious; Staphylococcal Infections; Staphylococcus aureus

Topics: Anti-Bacterial Agents; Drug Resistance, Microbial; Fatty Acids; Female; Humans; Mupirocin; Skin Diseases, Infectious; Staphylococcal Infections; Staphylococcus aureus

Topics: Administration, Topical; Anti-Bacterial Agents; Fatty Acids; Humans; Mupirocin; Skin Diseases, Infectious

Topics: Administration, Topical; Drug Evaluation; Fatty Acids; Female; Humans; Mupirocin; Ointments; Skin Diseases, Infectious

Mupirocin (pseudomonic acid A), an antibiotic produced by Pseudomonas fluorescens, showed a high level of activity against staphylococci and streptococci and against certain gram-negative bacteria, including Haemophilus influenzae and Neisseria gonorrhoeae, but was much less active against most gram-negative bacilli an anaerobes. Nearly all clinical isolates of Staphylococcus aureus and Staphylococcus epidermidis, including multiply resistant strains, were susceptible (mupirocin MIC, less than or equal to 0.5 microgram/ml). There was no cross-resistance between mupirocin and clinically available antibiotics, and the selection of resistant variants in vitro occurred at a low frequency. Mupirocin was highly bound (95% bound) to the protein of human serum, and activity was reduced 10- to 20-fold in the presence of human serum. The activity of mupirocin was not greatly influenced by inoculum size but was significantly enhanced in acid medium. In tests of bactericidal activity, MBCs were 8- to 32-fold higher than MICs and the antibiotic demonstrated a slow bactericidal action in time-kill tests, resulting in 90 to 99% killing after 24 h at 37 degrees C.

Topics: Anti-Bacterial Agents; Bacteria; Culture Media; Drug Resistance, Microbial; Fatty Acids; Humans; Hydrogen-Ion Concentration; Microbial Sensitivity Tests; Mupirocin; Protein Binding; Skin Diseases, Infectious; Staphylococcus; Streptococcus

A preliminary trial is reported studying the effectiveness of pseudomonic acid in primary superficial skin infections in 20 patients. Staphylococcus aureus was isolated in 18 patients and beta-haemolytic streptococci group A in two. Only on one occasion was a pathogenic organism, Staph. aureus, isolated post-treatment and clinical cure or improvement was achieved in 19/20 (95%) of patients. All isolates were found to have pseudomonic acid MICs of between 0.06 and 0.25 mg/l.

Topics: Administration, Topical; Anti-Bacterial Agents; Fatty Acids; Humans; Mupirocin; Skin Diseases, Infectious; Staphylococcal Infections

Topics: Anti-Bacterial Agents; Fatty Acids; Humans; Mupirocin; Skin Diseases, Infectious