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All about: Mupirocin (Pseudomonic Acid A)

Big Image ( Pseudomonic Acid A ) Pronouncation: (myoo-PIHR-oh-sin)
Class: Antibiotic agent

Trade Names:
Bactroban
- Ointment 2%
- Cream 2%

Trade Names:
Bactroban Nasal
- Ointment 2%

Mechanism of Action

Pharmacology

Inhibits bacterial protein synthesis.

Pharmacokinetics

Absorption

Cream

Systemic absorption of mupirocin through human intact skin is minimal by detection of the metabolite, monic acid, in urine. More frequent occurrence of percutaneous absorption in children (90%) was found compared with adults (44%). Mupirocin is highly protein bound (more than 97%).

Ointment

Measurable systemic absorption.

Nasal

No evidence of systemic absorption.

Metabolism

Any mupirocin reaching the systemic circulation is rapidly metabolized, predominantly to inactive monic acid, which is eliminated by renal excretion. The elimination t ½ after IV administration was 20 to 40 min for mupirocin and 30 to 80 min for monic acid.

Indications and Usage

Treatment of impetigo caused by Staphylococcus aureus and Streptococcus pyogenes (topical ointment); treatment of secondarily infected traumatic skin lesions (up to 10 cm in length or 100 cm 2 in area) caused by susceptible strains of S. aureus and S. pyogenes (topical cream); eradication of nasal colonization with methicillin-resistant S. aureus in adult patients and health care workers (nasal).

Contraindications

Standard considerations.

Dosage and Administration

Adults and Children

Topical ointment Apply small amount to affected area tid. Reevaluate lesions not showing a response in 3 to 5 days. Topical cream Apply small amount to affected area tid for 10 days. Reevaluate lesions not showing a response in 3 to 5 days.

Adults and Children 12 yr and older

Nasal Divide approximately one-half of the ointment from a single-use tube between the nostrils and apply morning and evening for 5 days.

Storage/Stability

Store topical ointment at controlled room temperature (68° to 77°F). Store nasal ointment and topical cream below 77°F. Protect cream from freezing.

Drug Interactions

None well documented.

Laboratory Test Interactions

None well documented.

Adverse Reactions

CNS

Topical

Headache (2%).

Nasal

Headache (9%).

Dermatologic

Topical

Burning, stinging, pain, pruritus (2%); itching (1%); secondarily infected eczema.

Nasal

Burning, stinging (2%); pruritus (1%).

EENT

Nasal

Rhinitis (6%); pharyngitis (4%); taste perversion (3%); burning, stinging cough (2%).

GI

Topical

Nausea (5%) (secondary infected eczema).

Respiratory

Nasal

Respiratory disorder (5%); cough (2%).

Precautions

Pregnancy

Category B .

Lactation

Undetermined.

Children

Ointment and cream

Safety and efficacy have been established in children 2 mo to 16 yr (ointment) and in children 3 mo to 16 yr (cream).

Nasal

Safety and efficacy not established in children under 12 yr.

Hypersensitivity

Chemical irritation may occur.

Superinfection

Prolonged use of antibiotics may result in overgrowth of nonsusceptible organisms, including fungi.

Open wounds (ointment only)

Because polyethylene glycol can be absorbed from open wounds and damaged skin and is excreted by the kidneys, do not use if absorption of large quantities is possible, especially if evidence of moderate or severe renal impairment.

Prophylaxis

Insufficient data to recommend use of mupirocin nasal for general prophylaxis of any infection.

Patient Information

  • Warn the patient to avoid contact of drug with eyes and mucous membranes.
  • Instruct patient to wash hands before and after application.
  • Tell patient to inform health care provider if no improvement is seen within 3 to 5 days or if condition worsens.
  • Advise patient to keep fingernails well trimmed to prevent scratching.
  • Review with patient and family appropriate hygiene measures to prevent spread of impetigo.
  • Instruct patient to report the following symptoms to health care provider: burning, stinging, pain, nausea, tenderness, swelling, rash, dry skin, increased exudate.

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