BACTROBAN
Clinical safety rating: caution
Comprehensive clinical and safety monograph for BACTROBAN (BACTROBAN).
Binds to isoleucyl-tRNA synthetase, inhibiting bacterial protein synthesis.
| Metabolism | Minimal systemic absorption; rapidly metabolized to monic acid (inactive) in skin and systemically. |
| Excretion | Renal (90-95% unchanged), with minor biliary/fecal elimination (<5%) |
| Half-life | Terminal elimination half-life: 1-1.5 hours in adults with normal renal function; prolonged in renal impairment (up to 30 hours in end-stage renal disease) |
| Protein binding | 95% bound, primarily to albumin |
| Volume of Distribution | 0.15-0.3 L/kg, indicating distribution primarily into extracellular fluid |
| Bioavailability | Topical: Negligible systemic absorption (<0.05% after topical application to intact skin; slightly higher (up to 1%) on abraded skin; intranasal: <0.1% |
| Onset of Action | Topical: Within 24-48 hours for reduction of bacterial burden; intranasal: detectable mupirocin levels after 3-5 days of twice-daily application |
| Duration of Action | Topical: Therapeutic effect up to 4-6 hours after single application, requiring multiple daily dosing; clinical eradication of MRSA colonization typically after 5-7 days of intranasal therapy |
| Action Class | Cell membrane active agent |
| Brand Substitutes | BaciFoe Ointment, Mupisone Ointment, Mupisoft Ointment, T-Bact 2% Ointment, Muzes Ointment, M-Sys Cream, Mupizer 2% Cream, Mupitone 2% Cream, Supirocin Cream, Mupirid Cream |
Mupirocin (Bactroban) 2% ointment or cream applied topically to affected area three times daily for 5 to 14 days. For intranasal use: 0.5 g of 2% ointment applied to each nostril twice daily for 5 days.
| Dosage form | OINTMENT |
| Renal impairment | No dosage adjustment necessary for topical application. For intranasal use, no adjustment required. Systemic absorption is minimal. |
| Liver impairment | No dosage adjustment necessary for topical or intranasal use. Systemic absorption is minimal. |
| Pediatric use | Children 3 months and older: Same as adult dosing. Topical: apply 2% ointment/cream three times daily for 5 to 14 days. Intranasal: apply 0.5 g of 2% ointment to each nostril twice daily for 5 days. |
| Geriatric use | No specific adjustments required. Use same dosing as adults. Caution in patients with renal impairment due to potential accumulation of polyethylene glycol vehicle with extensive use on open wounds or burns. |
| 1st trimester | Consult provider |
| 2nd trimester | Consult provider |
| 3rd trimester | Consult provider |
Clinical note
Comprehensive clinical and safety monograph for BACTROBAN (BACTROBAN).
| Breastfeeding | Unknown if excreted in human milk; caution advised. M/P ratio not established. |
| Teratogenic Risk | No evidence of teratogenicity in animal studies; limited human data; FDA Pregnancy Category B. Use only if clearly needed. |
| Fetal Monitoring | None specifically required; monitor for local irritation or sensitization. |
■ FDA Black Box Warning
None.
| Serious Effects |
Known hypersensitivity to mupirocin or any component of the formulation.
| Precautions | Severe allergic reactions including anaphylaxis and angioedema; potential for superinfection with prolonged use; not for intranasal use except specific formulations. |
| Food/Dietary | No known food interactions. The drug is applied topically; oral intake does not affect its action. |
| Clinical Pearls | BACTROBAN (mupirocin) is a topical antibiotic effective against methicillin-resistant Staphylococcus aureus (MRSA) and Streptococcus pyogenes. It is contraindicated for use on burns or large open wounds due to risk of polyethylene glycol absorption. For impetigo, apply to affected area three times daily for 5-10 days. Not effective against fungal, viral, or anaerobic infections. Monitor for local irritation; discontinue if severe. Use intranasal formulation (BACTROBAN Nasal) for MRSA decolonization. |
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| Fertility Effects | No known effects on fertility. |
| Patient Advice | Apply a small amount of ointment to the affected area 3 times daily, or as directed. · Wash hands before and after application to prevent spreading infection. · Do not use on large areas of broken skin or deep wounds without medical advice. · Avoid contact with eyes and mucous membranes. · Complete the full course of treatment even if symptoms improve. · Stop use and contact doctor if rash or irritation occurs. · Do not share this medication with others. |