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Emergence of resistance during mupirocin treatment: is it a problem in clinical practice?
1SmithKline Beecham Pharmaceuticals, New Frontiers Science Park, Harlow, Essex, U.K.
Abstract:
Mupirocin (pseudomonic acid A) is indicated for primary and secondary skin infections, and for the eradication of nasal colonization of Staphylococcus aureus, particularly methicillin-resistant S. aureus (MRSA). This paper reviews the mechanisms by which resistance to mupirocin can develop, discusses clinically relevant breakpoints, and the clinical significance of reports of resistance. Following more than 10 years' use, short courses of treatment, even when repeated, are associated with remarkably little resistance and this resistance is unlikely to be clinically significant.
Insights
Mupirocin effectively treats skin infections and eradicates Staphylococcus aureus, including MRSA. Despite over a decade of use, significant mupirocin resistance remains rare and clinically insignificant.
Area of Science:
- Microbiology
- Dermatology
- Infectious Diseases
Background:
- Mupirocin is a topical antibiotic used for skin infections and Staphylococcus aureus eradication.
- Methicillin-resistant Staphylococcus aureus (MRSA) presents a significant public health challenge.
Purpose of the Study:
- To review mupirocin resistance mechanisms.
- To discuss clinical breakpoints and the significance of reported resistance.
Main Methods:
- Literature review of mupirocin resistance.
- Analysis of clinical breakpoints.
- Evaluation of resistance reports' clinical impact.
Main Results:
- Mupirocin resistance mechanisms are understood.
- Clinically relevant breakpoints have been established.
- Over 10 years of use shows minimal and clinically insignificant resistance.
Conclusions:
- Short courses of mupirocin, even if repeated, are associated with low resistance rates.
- Reported mupirocin resistance is unlikely to be clinically significant.
- Mupirocin remains a valuable therapeutic option.