Drugs List

Therapeutic Indications

Uses

Secondary skin infections due to susceptible strains S.aureus + S.pyogenes

Contraindications

Children under 1 year

Precautions and Warnings

Breastfeeding
Pregnancy

Contains benzyl alcohol
Contains cetyl alcohol - may cause local skin reactions
Avoid contact with eyes
Breastfeeding: Wash product off breasts prior to breastfeeding infant
Do not mix with other drugs or substances
Consider pseudomembranous colitis if patient presents with diarrhoea
Prolonged use may result in superinfection with non-susceptible organisms
Discontinue if irritation or sensitisation occur
Discontinue if severe and persistent diarrhoea develops
If no clinical response after 3-5 days consider alternative treatment
Length of treatment should not exceed 10 days
Advise patient residue on clothing/bedding may cause fire hazard
Fire hazard: Keep away from naked flames and potential sources of ignition

Pregnancy and Lactation

Pregnancy

Use mupirocin with caution in pregnancy.

At the time of writing there is limited published information regarding the use of mupirocin during pregnancy. It is not known whether mupirocin crosses the placenta, however the low molecular weight, of approximately 501, suggests it does (Briggs et al, 2015). Rapid metabolism of the drug proposes that it is unlikely mupirocin reaches the foetus in significant clinical amounts.

Animal studies have shown no evidence of harm to the foetus when used during pregnancy. Schaefer (2015) supports this evidence stating no undesirable effects have been recorded.

The manufacturer suggested to only use mupirocin if the potential benefit to the mother outweighs any potential risks to the foetus.

The use of all medication in pregnancy should be avoided whenever possible; particularly in the first trimester. Non-drug treatments should also be considered. When essential, a medication with the best safety record over time should be chosen, employing the lowest effective dose for the shortest possible time. Polypharmacy should be avoided. Teratogens taken in the pre-embryonic period, often quoted as lasting until 14 to 17 days post-conception, are believed to have an all-or-nothing effect. Where drugs have a short half-life, and when the date of conception is certain, this may allow women to be reassured where drug exposure has occurred within this time frame. Further advice may be available from the UK National Teratology Information Service (NTIS) and through ToxBase, available via password on the internet ( www.toxbase.org ) or if this is unavailable at the backup site ( www.toxbasebackup.org ).

Lactation

Use mupirocin with caution in breastfeeding.

At the time of writing there is limited published information regarding the use of mupirocin during breastfeeding. Briggs (2015) states the molecular weight of mupirocin suggests it is low enough to be excreted into breast milk however the fast elimination of the drug proposes significant clinical amounts are unlikely to be excreted. Studies have shown topical preparations of mupirocin are only minimally absorbed and readily metabolised suggesting it is safe to use during breastfeeding (Hale et al, 2014). Schaefer (2015) also states mupirocin is unlikely to cause harm to the infant if used in breastfeeding.

The manufacturer suggests if mupirocin is used during breastfeeding, wash the area thoroughly prior to breastfeeding.

Neonates, infants born prematurely, those with low birth weight, those with an unstable gastrointestinal function or who have serious illnesses may require special consideration. For any infant, if a drug is prescribed to the nursing mother, it should be at the lowest practical dose and for the shortest time. When drug administration is unavoidable and breastfeeding is to continue, minimisation of exposure of the infant to the drug may sometimes be achieved by timing the maternal doses to just after a feeding episode. Infants exposed to drugs via breast milk should be monitored for unusual signs or symptoms. Interactions between the drug received by the infant from the mother's milk and medication prescribed for the infant should also be considered, for example, when the drug given to the infant may prevent metabolism of the drug received via breast milk.
Specialist advice is available from the UK Drugs in Lactation Advisory Service at https://www.midlandsmedicines.nhs.uk/content.asp?section=6&subsection=17&pageIdx=1

Side Effects

Burning sensation
Contact dermatitis
Dry skin
Erythema
Hypersensitivity reactions
Pruritus
Rash
Urticaria

Presentation

Topical formulation of mupirocin

Drugs List

Therapeutic Indications

Uses

Secondary skin infections due to susceptible strains S.aureus + S.pyogenes

Dosage

Adults

Elderly

Children

Contraindications

Children under 1 year

Precautions and Warnings

Breastfeeding
Pregnancy

Contains benzyl alcohol
Contains cetyl alcohol - may cause local skin reactions
Avoid contact with eyes
Breastfeeding: Wash product off breasts prior to breastfeeding infant
Do not mix with other drugs or substances
Consider pseudomembranous colitis if patient presents with diarrhoea
Prolonged use may result in superinfection with non-susceptible organisms
Discontinue if irritation or sensitisation occur
Discontinue if severe and persistent diarrhoea develops
If no clinical response after 3-5 days consider alternative treatment
Length of treatment should not exceed 10 days
Advise patient residue on clothing/bedding may cause fire hazard
Fire hazard: Keep away from naked flames and potential sources of ignition

Pregnancy and Lactation

Pregnancy

Use mupirocin with caution in pregnancy.

At the time of writing there is limited published information regarding the use of mupirocin during pregnancy. It is not known whether mupirocin crosses the placenta, however the low molecular weight, of approximately 501, suggests it does (Briggs et al, 2015). Rapid metabolism of the drug proposes that it is unlikely mupirocin reaches the foetus in significant clinical amounts.

Animal studies have shown no evidence of harm to the foetus when used during pregnancy. Schaefer (2015) supports this evidence stating no undesirable effects have been recorded.

The manufacturer suggested to only use mupirocin if the potential benefit to the mother outweighs any potential risks to the foetus.

The use of all medication in pregnancy should be avoided whenever possible; particularly in the first trimester. Non-drug treatments should also be considered. When essential, a medication with the best safety record over time should be chosen, employing the lowest effective dose for the shortest possible time. Polypharmacy should be avoided. Teratogens taken in the pre-embryonic period, often quoted as lasting until 14 to 17 days post-conception, are believed to have an all-or-nothing effect. Where drugs have a short half-life, and when the date of conception is certain, this may allow women to be reassured where drug exposure has occurred within this time frame. Further advice may be available from the UK National Teratology Information Service (NTIS) and through ToxBase, available via password on the internet ( www.toxbase.org ) or if this is unavailable at the backup site ( www.toxbasebackup.org ).

Lactation

Use mupirocin with caution in breastfeeding.

At the time of writing there is limited published information regarding the use of mupirocin during breastfeeding. Briggs (2015) states the molecular weight of mupirocin suggests it is low enough to be excreted into breast milk however the fast elimination of the drug proposes significant clinical amounts are unlikely to be excreted. Studies have shown topical preparations of mupirocin are only minimally absorbed and readily metabolised suggesting it is safe to use during breastfeeding (Hale et al, 2014). Schaefer (2015) also states mupirocin is unlikely to cause harm to the infant if used in breastfeeding.

The manufacturer suggests if mupirocin is used during breastfeeding, wash the area thoroughly prior to breastfeeding.

Neonates, infants born prematurely, those with low birth weight, those with an unstable gastrointestinal function or who have serious illnesses may require special consideration. For any infant, if a drug is prescribed to the nursing mother, it should be at the lowest practical dose and for the shortest time. When drug administration is unavoidable and breastfeeding is to continue, minimisation of exposure of the infant to the drug may sometimes be achieved by timing the maternal doses to just after a feeding episode. Infants exposed to drugs via breast milk should be monitored for unusual signs or symptoms. Interactions between the drug received by the infant from the mother's milk and medication prescribed for the infant should also be considered, for example, when the drug given to the infant may prevent metabolism of the drug received via breast milk.
Specialist advice is available from the UK Drugs in Lactation Advisory Service at https://www.midlandsmedicines.nhs.uk/content.asp?section=6&subsection=17&pageIdx=1

Side Effects

Burning sensation
Contact dermatitis
Dry skin
Erythema
Hypersensitivity reactions
Pruritus
Rash
Urticaria

Overdosage

It is strongly recommended that the UK National Poisons Information Service be consulted on cases of suspected or actual overdose where there is doubt over the degree of risk or about appropriate management.

The following number will direct the caller to the relevant local centre (0844) 892 0111

Information may be obtained if you have access to ToxBase the primary clinical toxicology database of the National Poisons Information Service. This is available via password on the internet ( www.toxbase.org ) or if this is unavailable at the backup site ( www.toxbasebackup.org ).

Further Information

Last Full Review Date: March 2017

Reference Sources

Drugs During Pregnancy and Lactation: Treatment Options and Risk Assessment, 3rd edition (2015) ed. Schaefer, C., Peters, P. and Miller, R. Elsevier, London.

Drugs in Pregnancy and Lactation: A Reference Guide to Fetal and Neonatal Risk, 10th edition (2015) ed. Briggs, G., Freeman, R. Wolters Kluwer Health, Philadelphia.

Joint Formulary Committee. British National Formulary. 72nd ed. London: BMJ Group and Pharmaceutical Press; 2016.

Medications and Mothers' Milk, Sixteenth Edition (2014) Hale, T and Rowe, H, Hale Publishing, Plano, Texas.

Paediatric Formulary Committee. BNF for Children 2016-2017. London: BMJ Group, Pharmaceutical Press, and RCPCH Publications; 2016.

Summary of Product Characteristics: Bactroban 2% Cream. GlaxoSmithKline UK. Revised June 2015.