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Topical antibiotic (pseudomonic acid) Pregnancy: Compatible — topical use considered safe; avoid large surface area application.

Mupirocin 2% Ointment

Brand names: Bactroban (2% ointment, 2% nasal ointment)

Adult dose

Dose: Apply 3 times daily to affected area
Route: Topical (skin ointment); nasal ointment (MRSA decolonisation)
Frequency: Three times daily for up to 10 days
Max: Up to 10 days continuous use — do not use longer (resistance risk)
Impetigo: apply TDS for 5–10 days. Infected eczema / secondary bacterial skin infection: apply TDS. MRSA nasal decolonisation: Bactroban nasal ointment 3 times daily for 5 days (protocol-driven — usually with chlorhexidine body wash). Do not use on large surface areas (polyethylene glycol base — renal toxicity risk in impaired kidneys).

Paediatric dose

Route: Topical
Frequency: 3 times daily
Max: Up to 10 days
Concentration: 2% ointment Application/ml
Safe in children of all ages (neonates included under specialist guidance). Impetigo in children: 5–10 days TDS application. Nasal MRSA decolonisation protocol applies to children too.

Dose adjustments

Renal

Avoid application to large body surface areas in renal impairment — polyethylene glycol base absorbed through skin and renally excreted.

Hepatic

No adjustment for topical use on small areas.

Clinical pearls

  • First-line topical antibiotic for impetigo (NICE NG153): 2% mupirocin ointment TDS for 5 days
  • MRSA decolonisation protocol (PHE/NICE): mupirocin nasal ointment + chlorhexidine body wash for 5 days — highly effective
  • Resistance risk: restrict to licensed indications and short courses only — do not use prophylactically long-term
  • Unique mechanism (inhibits bacterial isoleucyl-tRNA synthetase) — no cross-resistance with other antibiotic classes
  • For widespread impetigo or systemic features: use oral flucloxacillin or cefalexin — topical mupirocin for localised disease only

Contraindications

  • Hypersensitivity to mupirocin or polyethylene glycol
  • Application to large surface areas in renal impairment

Side effects

  • Local burning, stinging, and itching
  • Skin dryness at application site
  • Contact dermatitis (rare)
  • Resistance (Staphylococcus aureus MRSA low-level resistance with overuse)

Interactions

  • No significant systemic drug interactions at topical doses

Monitoring

  • Clinical response at 5–7 days
  • Signs of developing resistance (treatment failure)
  • MRSA decolonisation — swab at 48h post-treatment

Reference: BNFc; BNF; NICE NG153 Impetigo; PHE MRSA Decolonisation Guidance; BAD Impetigo Guidelines. Verify against your local formulary and the latest BNF before prescribing.

Related

Curated clinical cross-links plus same-class fallbacks.

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