title: Comparative study of mupirocin and oral co-trimoxazole plus topical fusidic acid in eradication of nasal carriage of methicillin-resistant Staphylococcus aureus.
abstract: Mupirocin is a topically applied drug that is very active in the eradication of nasal carriage of methicillin-resistant Staphylococcus aureus (MRSA). However, studies designed to compare mupirocin treatment with other antimicrobial regimens are lacking. We therefore conducted an open, prospective, randomized, controlled trial to compare the efficacy and safety of mupirocin versus those of oral co-trimoxazole plus topical fusidic acid (both regimens with a clorhexidine scrub bath) for the eradication of MRSA from nasal and extranasal carriers of MRSA. The eradication rates with mupirocin and co-trimoxazole plus fusidic acid at 2, 7, 14, 21, 28, and 90 days were 93 and of 93, 100 and 100, 97 and 94, 100 and 92, 96 and 95, and 78 and 71%, respectively, for nasal carriage. At 7, 14, and 28 days the eradication rates for extranasal carriage by the two regimens were 23 and 74, 83 and 76, and 45 and 69%, respectively. The efficacies and safety of both regimens were similar. The MRSA isolates were not resistant to the study drugs either at the baseline or at follow-up. These results suggest that mupirocin and co-trimoxazole plus fusidic acid, both used in conjunction with a chlorhexidine soap bath, are equally effective and safe for the eradication of MRSA from nasal and extranasal MRSA carriers. Mupirocin was easier to use but was more expensive.
authors.affiliation: Department of Clinical Microbiology and Infectious Diseases, Hospital Gregorio Marañón, Madrid, Spain.
authors.forename: F
authors.initials: F
authors.lastname: Parras
authors.forename: M C
authors.initials: MC
authors.lastname: Guerrero
authors.forename: E
authors.initials: E
authors.lastname: Bouza
authors.forename: M J
authors.initials: MJ
authors.lastname: Blázquez
authors.forename: S
authors.initials: S
authors.lastname: Moreno
authors.forename: M C
authors.initials: MC
authors.lastname: Menarguez
authors.forename: E
authors.initials: E
authors.lastname: Cercenado
mesh_terms: D000284:Administration, Oral; D000287:Administration, Topical; D003428:Cross Infection / Q000188:drug therapy / Q000382:microbiology; D004359:Drug Therapy, Combination; D005260:Female; D005672:Fusidic Acid / Q000008:administration & dosage*; D006801:Humans; D008297:Male; D016106:Methicillin Resistance; D008875:Middle Aged; D016712:Mupirocin / Q000627:therapeutic use*; D009296:Nasal Cavity / Q000382:microbiology*; D011446:Prospective Studies; D013203:Staphylococcal Infections / Q000188:drug therapy* / Q000382:microbiology; D013211:Staphylococcus aureus / Q000187:drug effects* / Q000302:isolation & purification; D015662:Trimethoprim, Sulfamethoxazole Drug Combination / Q000008:administration & dosage / Q000627:therapeutic use*
chemical_list: D005672:Fusidic Acid; D015662:Trimethoprim, Sulfamethoxazole Drug Combination; D016712:Mupirocin