Primary Skin Infections Research Articles

Overview of the role of mupirocin

Mupirocin is a novel antibiotic, for topical use only, which is unrelated in chemical structure and mode of action to any known class of antibacterial agent. It is active against a wide range of Gram-positive bacteria, including staphylococci and most streptococci, and is moderately active against Gram-negative bacteria. Mupirocin 2% ointment applied 2 or 3 times daily has demonstrable efficacy for the treatment of both primary and secondary skin infections and compares favourably with other topical and systemic treatments. In clinical studies, both elimination of the bacterial pathogen and clinical cure or improvement has been usual in over 90% of patients. Up to 40% of the normal population carry Staphylococcus aureus in the anterior nares and this carriage rate is often increased in hospitalized patients and their attendants. The increasing incidence of multiply- and methicillin-resistant S. aureus (MRSA) has been associated with hospital outbreaks leading to considerable morbidity and disruption of hospital services. Intranasal 2% calcium mupirocin has been shown to be effective in the eradication of nasal carriage; in bacteriologically controlled studies elimination of S. aureus, including MRSA, was achieved in over 95% of subjects. The role of mupirocin in preventing staphylococcal infection is currently undergoing evaluation.

The uses and abuses of mupirocin

Mupirocin is a new antibiotic available for topical use. It is valuable for both primary and secondary skin infections with Staphylococci and Streptococci, but Cornyeforms are uniformly insensitive. It is an excellent agent for the elimination of nasal Staphylococci in patients and staff. Resistant Staphylococci have already appeared, chiefly associated with prolonged use of the antibiotic, but these are few in number and do not detract from the value of the antibiotic when used in accordance with recommendations.

Mupirocin is effective against primary and secondary skin infections

Mupirocin is effective against primary and secondary skin infections

Efficacy and safety of 2% mupirocin ointment in the treatment of primary and secondary skin infections — an open multicentre trial

International Journal of Clinical PracticeVolume 43, Issue 8 p. 284-288 Clinical Study Efficacy and safety of 2% mupirocin ointment in the treatment of primary and secondary skin infections — an open multicentre trial K Bork, K Bork Consultant Dermatologist University Hospital, MainzSearch for more papers by this authorJ Brauers PhD, J Brauers PhD Clinical Research Associate Beecham-Wülfing GmbH & Co KG, Neuss, Federal Republic of GermanySearch for more papers by this authorM Kresken PhD, Corresponding Author M Kresken PhD Medical Adviser n/[email protected] Beecham-Wülfing GmbH & Co KG, Neuss, Federal Republic of GermanyAddress correspondence to Dr M Kresken, Medical Department, Beecham-Wülfing GmbH & Co KG. Stresemannallee 6, 4040 Neuss 1, Federal Republic of Germany.Search for more papers by this author K Bork, K Bork Consultant Dermatologist University Hospital, MainzSearch for more papers by this authorJ Brauers PhD, J Brauers PhD Clinical Research Associate Beecham-Wülfing GmbH & Co KG, Neuss, Federal Republic of GermanySearch for more papers by this authorM Kresken PhD, Corresponding Author M Kresken PhD Medical Adviser n/[email protected] Beecham-Wülfing GmbH & Co KG, Neuss, Federal Republic of GermanyAddress correspondence to Dr M Kresken, Medical Department, Beecham-Wülfing GmbH & Co KG. Stresemannallee 6, 4040 Neuss 1, Federal Republic of Germany.Search for more papers by this author First published: 01 August 1989 https://doi.org/10.1111/j.1742-1241.1989.tb08744.xRead the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Volume43, Issue8August 1989Pages 284-288 RelatedInformation

Topical 2% mupirocin versus 2% fusidic acid ointment in the treatment of primary and secondary skin infections

The efficacy and side effects of topical mupirocin (Bactroban) and fusidic acid (Fucidin) ointment were compared in a double-blind, randomized trial in 70 patients who came to the Dermatologic Clinic of L'Enfant Jésus Hospital with primary or secondary (or both) skin infections. Thirty-five patients were treated with mupirocin and 35 patients were treated with fusidic acid three times a day for seven days. Clinical and bacteriologic assessments were conducted before and after treatment. The efficacy of mupirocin, in terms of resolution and improvement of clinical signs and symptoms of infection, as well as of the elimination of infecting organisms, was similar to that of fusidic acid. Of 34 patients (1 could not be evaluated) treated with mupirocin, a clinical cure was achieved in 18, and significant improvement was demonstrated in 15. Similarly, of 35 patients treated with fusidic acid, a clinical cure was achieved in 18 and improvement occurred in 15. Bacteriologic cure rates were 97% (30 of 31 patients evaluated) in the mupirocin-treated group, compared with 87% (27 of 31 patients evaluated) in the fusidic acid-treated group. No side effects were observed in either treatment group. Because topical 2% mupirocin has little or no potential for irritation, systemic side effects, or cross-resistance with other antibiotics, its efficacy is likely to make this new compound a useful agent for the treatment of superficial skin infections.

Topical antibiotics in the treatment of superficial skin infections in general practice—A comparison of mupirocin with sodium fusidate

A total of 413 eligible patients took part in an observer-blind randomised multicentre clinical trial in order to compare the clinical and bacteriological efficacy of mupirocin (Bactroban) ointment with sodium fusidate (Fucidin) ointment for treating superficial skin infections seen in general practice. Mupirocin was applied twice daily and sodium fusidate thrice daily for a period of 7 days. Both treatments were similarly effective with 97% patients treated with mupirocin and 93% patients treated with sodium fusidate responding. Mupirocin was significantly more effective in the treatment of acute primary skin infections and in the treatment of a subgroup of patients with impetigo (P less than 0.01). Of the organisms detected before treatment began, 93% were not found after treatment with mupirocin compared with 89% after treatment with sodium fusidate. Staphylococcus aureus and/or beta-haemolytic streptococci appeared to be eliminated in significantly more patients treated with mupirocin (96%) compared with those treated with sodium fusidate (88%), (P = 0.03). Both treatments were well tolerated.

An evaluation of topical mupirocin in moderately severe primary and secondary skin infections.

Five days' treatment with topical mupirocin, applied twice daily, in 36 patients with moderately severe primary and secondary skin infections, resulted in resolution/much improvement of skin lesions in 75.0% of patients and bacterial eradication in 83.9% of cases. Penicillin-resistant and penicillin-sensitive staphylococci were most commonly implicated. No adverse effects were reported in any of the patients treated. Physicians' assessment of cure/improvement was recorded in 91.7% of patients.

Efficacy of Mupirocin 2% Ointment in Skin Infections: Belgian Prospective Open Multicenter Study

Seven Belgian dermatology clinics participated in a multicenter study aimed at evaluating the efficacy of mupirocin ointment in the treatment of primary and secondary skin infections. 116 patients were enrolled in the study. Clinical assessment was possible in 110 patients, bacteriological assessment in 106. Clinical success rates were 93.3 and 90.8% for primary and secondary infections, respectively. Correspondingly, bacteriological eradication or complete healing was achieved in 97.7 and 87.1%, respectively. Side effects were mild and limited to 1 case of burning sensation and 1 case of stinging.

Topical mupirocin in the treatment of bacterial skin infections.

Mupirocin is an investigational topical antibiotic used for treatment and prophylaxis of bacterial skin infections. Mupirocin differs from other antibiotics in its synthesis, structure, and mechanism of action. In vitro, mupirocin possesses antimicrobial activity against staphylococci, streptococci, Hemophilus influenzae, and Neisseria gonorrhoeae. Few studies comparing mupirocin to other topical antibiotics are available. Initial studies comparing mupirocin to inactive vehicle in the treatment of impetigo indicate an overall 92 percent pathogen eradication rate with active drug and 58 percent eradication rate with vehicle. Overall response to treatment of secondary skin infections was favorable in 91 percent of patients treated with mupirocin and 77 percent of those treated with vehicle. Although incidence is not greater than placebo, adverse effects have included pruritus, burning, dry skin, and erythema. Additional trials and clinical use should further help determine the role of mupirocin in the treatment of minor, primary, and secondary skin infections.

Mupirocin. A review of its antibacterial activity, pharmacokinetic properties and therapeutic use.

Mupirocin (pseudomonic acid A) is a novel topical antibacterial agent which inhibits bacterial protein and RNA synthesis. It has excellent in vitro activity against staphylococci and most streptococci, but has less activity against other Gram-positive and most Gram-negative bacteria. Its rapid systemic metabolism means it will only be used topically which, combined with its novel chemical structure, should make cross-resistance less likely to occur than with other currently available topical antibacterial agents. Mupirocin 2% ointment administered 2 or 3 times daily has shown excellent efficacy in both primary and secondary superficial skin infections, usually with at least 80% of patients being clinically cured or markedly improved, and over 90% eradication of the bacterial pathogen involved. Efficacy in impetigo and, to a somewhat lesser extent, infected wounds has been particularly convincingly demonstrated, while in other secondary skin infections the clinical response seen with mupirocin was often similar to the high success rate of vehicle alone. Limited evidence suggests that mupirocin may be as effective as chlortetracycline, fusidic acid, neomycin and other antibacterial agents, but more controlled, comparative studies are needed. The evidence of efficacy against nasal carriage of Staphylococcus aureus, including methicillin-resistant forms, is encouraging and currently work is being undertaken to improve the acceptability of the vehicle for this use. Side effects are limited to local reactions (in less than 3% of patients) and are no more frequent than observed with the vehicle alone. Thus, mupirocin appears to be a useful addition to the agents available for the treatment of superficial primary skin infections, such as impetigo, although its precise place in therapy remains to be established.

Topical Antibiotic Treatment of Impetigo With Mupirocin

Because the effectiveness of topical antimicrobials in the treatment of ecthyma, impetigo, and pyoderma is not well established, the US Food and Drug Administration has recently proposed guidelines for tests of topical antimicrobial efficacy in primary skin infections. The guidelines require both comparison with the agent's base and microbiologic documentation of efficacy. These guidelines were followed in this double-blind, eight-day evaluation of impetigo/ecthyma treated with mupirocin, a new agent that is only active topically. All cultures, before and after therapy, were taken using swabs dipped in neutralizing broth plus 10% fetal bovine serum to minimize antimicrobial "carry over" to the culture plate. Staphylococcus aureus, which was isolated from 94% of the patients before therapy, was eliminated in 88% of the mupirocin-treated patients and 47% of the vehicle-treated patients. Group A beta-hemolytic streptococci were eliminated in 100% of the mupirocin-treated and 0% of the vehicle-treated patients. To our knowledge, this is the first topical antibacterial treatment for primary skin infections proved superior to its vehicle using the proposed US Food and Drug Administration guidelines.

Skin as a source for hospital infection.

The skin is itself the site of infection by many different bacteria. Dermatologists may see primary skin infection due toStaphylococcus aureus, beta hemolytic streptococci and a host of less common pathogens including gonococci, mycobacteria and even enterobacteriaceae, or secondary infection which is mostly staphylococcal in eczema or weighted toward Proteus and Pseudomonas in venous stasis ulcers. Geriatricians see a mixed microbial flora in decubitus ulcers while those who insert plastic prostheses, intravenous or abdominal catheters can expect infection with coagulase-negative or positive cocci.The skin also forms a natural reservoir of organisms available to infect a variety of patients and it is with the skin as a reservoir that this article is concerned. The normal flora of the skin in healthy subjects is composed chiefly of coagulase-negative cocci and coryneforms with gram-negative bacilli chiefly, but not entirely, represented by Acinetobacter. Patients admitted to the hospital who are severely ill may become more heavily colonized by gram-negative bacilli while frank skin lesions constitute a more obvious source of potential pathogens.

Treatment of skin and skin structure infections in the patient at risk

Infections of the skin and skin structures in patients at risk can be either primary or secondary. In the normal host, the most important primary dermal pathogens are the group A beta-hemolytic Streptococcus and Staphylococcus aureus. These organisms can spread rapidly and seed to distant sites. Secondary skin involvement occurs in several life-threatening bacteremic conditions in previously normal hosts, especially in those involving meningococci and S. aureus. In the compromised host, although the acute pyogenic bacteria just mentioned can be even more devastating, low grade pathogens or nonpathogenic members of the normal flora, or both, are commonly involved. Such organisms include gram-negative aerobic bacilli, a variety of anaerobes, several fungi, and the herpesviruses. Therapy of primary skin and skin structure infections invariably should include debridement along with antibiotic coverage. Debridement must be complete, opening all deep extensions of the primary infection and removing, to the extent possible, all foreign materials. In the normal host, antibiotic coverage must include a beta-lactamase-resistant antibiotic or vancomycin if beta-lactamase-resistant, antibiotic-resistant S. aureus could be involved. In the compromised host, signs of local inflammation may be reduced; yet, debridement must still be aggressive and antibiotic coverage broad. Neutropenic patients should be covered for Pseudomonas aeruginosa, requiring a combination of an antipseudomonal agent plus an aminoglycoside. Antifungal or antiviral therapy, or both, should be added in the severely compromised host in the proper setting, especially in patients not promptly responding to antibacterial measures. Attempts to enhance host defenses should be considered.

Pseudomonic acid--a new antibiotic for skin infections.

A preliminary trial is reported studying the effectiveness of pseudomonic acid in primary superficial skin infections in 20 patients. Staphylococcus aureus was isolated in 18 patients and beta-haemolytic streptococci group A in two. Only on one occasion was a pathogenic organism, Staph. aureus, isolated post-treatment and clinical cure or improvement was achieved in 19/20 (95%) of patients. All isolates were found to have pseudomonic acid MICs of between 0.06 and 0.25 mg/l.

Primary Cutaneous Aspergillosis in a Leukemic Child

Primary cutaneous aspergillosis is rare. In this report we describe a primary skin infection by Aspergillus flavus in a child with leukemia. The lesions were characterized by erythematous macules and papules associated with pain and itching, followed by a rapid progression to ulcers and central black eschars with a raised erythematous border. A favorable response to topical nystatin therapy was observed. The multiple cutaneous lesions seen in our patient were most likely due to primary inoculation near the site of intravenous infusion with subsequent local lymphatic spread.

Primary mycobacterial skin infection: A summary.

International Journal of DermatologyVolume 13, Issue 6 p. 353-356 PRIMARY MYCOBACTERIAL SKIN INFECTION: A SUMMARY ROGER A. FELDMAN M.D., Corresponding Author ROGER A. FELDMAN M.D. U. S. Department of Health, Education, and Welfare, Public Health Service, Center for Disease Control, Atlanta, GeorgiaAddress for reprints: Dr. Feldman, Bacterial Diseases Division, Bureau of Epidemiology, Center for Disease Control, Atlanta, Ga. 30333.Search for more papers by this author ROGER A. FELDMAN M.D., Corresponding Author ROGER A. FELDMAN M.D. U. S. Department of Health, Education, and Welfare, Public Health Service, Center for Disease Control, Atlanta, GeorgiaAddress for reprints: Dr. Feldman, Bacterial Diseases Division, Bureau of Epidemiology, Center for Disease Control, Atlanta, Ga. 30333.Search for more papers by this author First published: November 1974 https://doi.org/10.1111/j.1365-4362.1974.tb05067.xCitations: 9AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat Citing Literature Volume13, Issue6November 1974Pages 353-356 RelatedInformation

Indolent non-caseating Mycobacterial tuberculosis.

Atthepresent time,tuberculosis affecting the skinorthesmallbonesofthehandsandfeetis uncommoninGreatBritain. Outof2500cases of tuberculosis inchildren documented by Miller, Seal, andTaylor(1963), 34hada primary skin infection and28hadahaematogenous skininfection. Ofthese 28,only6wereoftheverrucous type.In their entire series theysawonly2cases oftuberculosisofthephalanges, andthese presented aspainless, spindle-shaped swelling oftheaffected phalanx with underlying radiologically detectable bonechanges. Thechild heredescribed embodied clinical features ofboththese raretypes, andthecaseraises some interesting questions. CaseReport A3-year-old girl presented withrecurrent boils, mainly situated onarmsandlegs, whichhadappeared overthe previous 9months(Fig. la,2).Threeinparticular kept breaking downandpersisting. Shehadalso experienced painaffecting theright ankle andterminal interphalangealjoint oftheleft indexfinger. Thesejoints were swollen andthere hadalsobeenswelling onherleft big toeandproximal phalanx oftheleft middle finger. The child hadbeenalittle apathetic butthere hadbeenno weight loss.Shehadreceived courses ofintramuscular andoral penicillin andoforal tetracycline without effect. Clinical examination onadmission revealed areas of inflammation on therightbuttock, rightthigh, and behind theright knee.Therewasspindling oftheleft middlefinger. Therewasnounduelymphadenopathy andnosplenomegaly. Bloodcountnormal.ESR 35mm. ASO titre 400 units. Totalplasmaproteins 8*3,albumin5 5, globulin 2 8 g./100ml. RA latextestnegative. Urinalysis normal.Heaftuberculin testnegative. X-rayfilmofleft handnormal. Swabsofthelesions grewbothastaphylococcus anda ,B-haemolytic streptococcus. Because ofthelatter she was givena courseofpenicillin. Itwasthought initially thatthese werestaphylococcal lesions, perhaps witha superadded secondary infection, and some corroboration forthisviewappeared intheformofa

Cutaneous Infection with Atypical Mycobacterium

Human infection caused by atypical Mycobacteria (that is, acid-fast bacilli other than the usual human, bovine, and avian tubercle bacillus and the bacillus of leprosy) is not common. Such atypical acid-fast infections, in fact, are more commonly pulmonary than cutaneous. 1 Observation of a primary skin infection caused by an atypical Mycobacterium prompts this report. Report of Case The patient, a 39-year-old white woman, was first seen Nov. 27, 1957, 2 days after she had been kicked in the upper mid-portion of the left thigh by a cow. Examination revealed a large hematoma. No active treatment was deemed necessary. When the patient returned Dec. 16, 1957, an abscess was present at the site of the previous hematoma. It was treated by incision and drainage, and oral tetracycline. Examination on Dec. 22 suggested that the infection had been cured. The patient returned Jan. 10, 1958, with 3 tender, inflammatory, fluctuant, subcutaneous