title: Drug utilization review of mupirocin ointment in a Korean university-affiliated hospital.
abstract: OBJECTIVE
  Intranasal mupirocin and chlorhexidine bathing are candidate strategies to prevent healthcare-associated infections caused by methicillin-resistant Staphylococcus aureus (MRSA). In Korea, intranasal mupirocin is not available, and mupirocin ointment, an over-the-counter drug, has been used indiscriminately. Furthermore, because it is covered by health insurance, mupirocin is easy to prescribe within hospitals.
  
  
  METHODS
  We performed a mupirocin drug utilization review (DUR) within Hallym University Sacred Heart Hospital. Annual use of mupirocin was investigated between 2003 and 2013, and monthly consumption of mupirocin was assessed during the final 2-year period. The DUR focused on August 2012, the period of highest use of mupirocin. Also, we investigated trends in mupirocin resistance in MRSA between 2011 and 2013.
  
  
  RESULTS
  Annual consumption of mupirocin increased from 3,529 tubes in 2003 to 6,475 tubes in 2013. During August 2012, 817 tubes were prescribed to 598 patients; of these, 84.9% were prescribed to outpatients, and 77.6% at the dermatology department. The most common indication was prevention of skin infections (84.9%), and the ointment was combined with systemic antibiotics in 62.9% of cases. The average duration of systemic antibiotic administration was about 7.8 days. The rate of low-level mupirocin resistance in MRSA increased from 8.0% to 22.0%, and that of high-level mupirocin resistance increased from about 4.0% to about 7.5%.
  
  
  CONCLUSIONS
  Inappropriate use of mupirocin is prevalent. Considering the increase in resistance and the future application of intranasal mupirocin, prophylactic use of mupirocin in dermatology departments should be reconsidered.
authors.affiliation: Division of Infectious Diseases, Department of Internal Medicine, Hallym University Sacred Heart Hospital, Anyang, Korea.
authors.forename: Sung Hee
authors.initials: SH
authors.lastname: Youn
authors.affiliation: Division of Infectious Diseases, Department of Internal Medicine, Hallym University Sacred Heart Hospital, Anyang, Korea.
authors.forename: Seung Soon
authors.initials: SS
authors.lastname: Lee
authors.affiliation: Division of Infectious Diseases, Department of Internal Medicine, Hallym University Sacred Heart Hospital, Anyang, Korea.
authors.forename: Sukyeon
authors.initials: S
authors.lastname: Kim
authors.affiliation: Division of Infectious Diseases, Department of Internal Medicine, Hallym University Sacred Heart Hospital, Anyang, Korea.
authors.forename: Jeong-A
authors.initials: JA
authors.lastname: Lee
authors.affiliation: Division of Infectious Diseases, Department of Internal Medicine, Hallym University Sacred Heart Hospital, Anyang, Korea.
authors.forename: Bum Joon
authors.initials: BJ
authors.lastname: Kim
authors.affiliation: Department of Pharmacy, Hallym University Sacred Heart Hospital, Anyang, Korea.
authors.forename: Jounghee
authors.initials: J
authors.lastname: Kim
authors.affiliation: Department of Pharmacy, Hallym University Sacred Heart Hospital, Anyang, Korea.
authors.forename: Hye-Kyung
authors.initials: HK
authors.lastname: Han
authors.affiliation: Department of Laboratory Medicine, Hallym University Kangdong Sacred Heart Hospital, Seoul, Korea.
authors.forename: Jae-Seok
authors.initials: JS
authors.lastname: Kim
mesh_terms: D000279:Administration, Cutaneous; D000900:Anti-Bacterial Agents / Q000008:administration & dosage* / Q000009:adverse effects; D011307:Drug Prescriptions; D024901:Drug Resistance, Multiple, Bacterial; D017723:Drug Utilization Review; D006785:Hospitals, University; D006801:Humans; D057970:Inappropriate Prescribing / Q000639:trends*; D055624:Methicillin-Resistant Staphylococcus aureus / Q000187:drug effects*; D008826:Microbial Sensitivity Tests; D016712:Mupirocin / Q000008:administration & dosage* / Q000009:adverse effects; D009824:Ointments; D010818:Practice Patterns, Physicians' / Q000639:trends*; D011237:Predictive Value of Tests; D056910:Republic of Korea; D012189:Retrospective Studies; D013207:Staphylococcal Skin Infections / Q000175:diagnosis / Q000188:drug therapy* / Q000382:microbiology; D013997:Time Factors
chemical_list: D000900:Anti-Bacterial Agents; D009824:Ointments; D016712:Mupirocin
keywords: Drug resistance, bacterial; Drug utilization review; Methicillin-resistant Staphylococcus aureus; Mupirocin