Drugs List

Therapeutic Indications

Uses

Bacterial skin infections

Treatment of bacterial skin infections such as impetigo, folliculitis and furunculosis.

It is active against staphylococci, including methicillin-resistant Staphylococcus aureus, streptococci and also Gram-negative organisms such as Escherichia coli and Haemophilus influenzae.

Contraindications

None known

Precautions and Warnings

Breastfeeding
Moderate renal impairment
Pregnancy

Contains polyethylene glycol
Some formulations contain butylated hydroxy toluene (E321)
Avoid contact with eyes
Avoid contact with mucous membranes
Breastfeeding: Wash product off breasts prior to breastfeeding infant
Discontinue if severe hypersensitivity reactions occur
Intolerable skin reaction: remove product by washing

Care should be taken to avoid contact with the eyes and mucous membranes.

In the event of a sensitisation reaction or severe local irritation, the ointment should be wiped off and appropriate alternative therapy instituted.

Avoid use in conjuction with cannulae or at the site of central venous cannulation.

Pregnancy and Lactation

Pregnancy

Mupirocin should be used with caution in pregnancy.

There is limited published information regarding the use of mupirocin during pregnancy.

The manufacturer states that mupirocin should only be used during pregnancy if the potential benefits outweigh the potential risks associated with treatment.

Briggs (2015) suggests a lack of embryo-foetal risk with mupirocin during pregnancy due to the minimal systemic concentration in addition to animal study data showing no evidence of foetal harm.

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 during breastfeeding.

If mupirocin is applied to the nipples, they should be thoroughly washed prior to breastfeeding.

Schaefer (2015) and Lactmed (2018) state that less than 1% is absorbed after topical application therefore mupirocin is considered a low risk to the nursing infant.

The minimal plasma concentration and rapid metabolism suggests clinically relevant concentrations will not appear in breast milk when the mother is treated with topical mupirocin (Briggs, 2015).

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

Allergic reaction
Anaphylaxis
Angioedema
Burning sensation (local)
Dry skin
Erythema
Itching
Rash
Sensitisation
Stinging
Urticaria

Presentation

Ointment containing mupirocin 2%.

Drugs List

Therapeutic Indications

Uses

Bacterial skin infections

Treatment of bacterial skin infections such as impetigo, folliculitis and furunculosis.

It is active against staphylococci, including methicillin-resistant Staphylococcus aureus, streptococci and also Gram-negative organisms such as Escherichia coli and Haemophilus influenzae.

Dosage

Adults

Children

Patients with Renal Impairment

Additional Dosage Information

Contraindications

None known

Precautions and Warnings

Breastfeeding
Moderate renal impairment
Pregnancy

Contains polyethylene glycol
Some formulations contain butylated hydroxy toluene (E321)
Avoid contact with eyes
Avoid contact with mucous membranes
Breastfeeding: Wash product off breasts prior to breastfeeding infant
Discontinue if severe hypersensitivity reactions occur
Intolerable skin reaction: remove product by washing

Care should be taken to avoid contact with the eyes and mucous membranes.

In the event of a sensitisation reaction or severe local irritation, the ointment should be wiped off and appropriate alternative therapy instituted.

Avoid use in conjuction with cannulae or at the site of central venous cannulation.

Pregnancy and Lactation

Pregnancy

Mupirocin should be used with caution in pregnancy.

There is limited published information regarding the use of mupirocin during pregnancy.

The manufacturer states that mupirocin should only be used during pregnancy if the potential benefits outweigh the potential risks associated with treatment.

Briggs (2015) suggests a lack of embryo-foetal risk with mupirocin during pregnancy due to the minimal systemic concentration in addition to animal study data showing no evidence of foetal harm.

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 during breastfeeding.

If mupirocin is applied to the nipples, they should be thoroughly washed prior to breastfeeding.

Schaefer (2015) and Lactmed (2018) state that less than 1% is absorbed after topical application therefore mupirocin is considered a low risk to the nursing infant.

The minimal plasma concentration and rapid metabolism suggests clinically relevant concentrations will not appear in breast milk when the mother is treated with topical mupirocin (Briggs, 2015).

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

Allergic reaction
Anaphylaxis
Angioedema
Burning sensation (local)
Dry skin
Erythema
Itching
Rash
Sensitisation
Stinging
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: November 2018

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.

NICE Evidence Services Available at: www.nice.org.uk Last accessed: 15 November 2018

Summary of Product Characteristics: Bactroban 2% Ointment. GlaxoSmithKline UK. Revised July 2016.

Summary of Product Characteristics: Mupirocin 20mg/g Ointment. Intrapharm Laboratories Limited. February 2016.

US National Library of Medicine. Toxicology Data Network. Drugs and Lactation Database (LactMed).
Available at: https://toxnet.nlm.nih.gov/cgi-bin/sis/htmlgen?LACT
Mupirocin. Last revised: 31 October 2018
Last accessed: 15 November 2018