Skip to content
ClinCalc Pro
Menu
Calculators Drugs Pathways AI Dx Donate Get the App
Topical antibiotic (mRNA synthetase inhibitor) Pregnancy: §4.6, verbatim: 'Pregnancy — Animal studies do not indicate reproductive toxicity (see section 5.3). As there is no clinical experience on its use during pregnancy, mupirocin should only be used in pregnancy when the potential benefits outweigh the possible risks of treatment. Breast-feeding — It is unknown whether mupirocin /metabolites are excreted in human milk. If a cracked nipple is to be treated, it should be thoroughly washed prior to breast feeding. Fertility — There are no data on the effects of mupirocin on human fertility. Studies in rats showed no effects on fertility (see section 5.3).'

Mupirocin 2% (Nasal / Wound)

Brand names: Bactroban

Mupirocin 2% is a topical antibacterial used for nasal decolonisation of Staphylococcus aureus (including MRSA) and for localised skin and wound infection; the nasal ointment and skin preparation are distinct formulations.

Adult dose

Dose: TOPICAL SKIN / WOUND USE ONLY (this dose is NOT for the nose): apply a thin layer of mupirocin 2% cream — 20 mg mupirocin per gram — to the affected area, three times a day for up to 10 days. §4.2 Posology, verbatim: 'Adults/children >= 1 year/elderly 3 times a day for up to 10 days, depending on the response.' §4.2 Method of administration, verbatim: 'A thin layer of cream should be applied to the affected area with a piece of clean cotton wool or gauze swab. The treated area may be covered by a dressing.' The label states no weight, volume or milligram quantity per application; strength is pinned by the product name and by US §3: 'Mupirocin cream USP, 2% is a white to off white cream that contains 20 mg (2% w/w) of mupirocin per gram'. NO NASAL DOSE IS PUBLISHED — see notes.
Route: Topical (cutaneous) cream, to intact or broken skin lesions/wounds. §4.4, verbatim: 'Bactroban Cream formulation is not suitable for ophthalmic use and intranasal use. Avoid contact with the eyes. If contaminated, the eyes should be thoroughly irrigated with water until the cream residues have been removed.' US §5.6, verbatim: 'Mupirocin cream is not formulated for use on mucosal surfaces. A separate formulation, BACTROBAN nasal ointment, is available for intranasal use.' That nasal product is NOT in this bundle.
Frequency: 3 times a day, for up to 10 days. §4.2, verbatim: 'Adults/children >= 1 year/elderly 3 times a day for up to 10 days, depending on the response.' US §2 cross-check: 'Apply a small amount of mupirocin cream, with a cotton swab or gauze pad, to the affected area 3 times daily for 10 days.'
SCOPE: this page covers two uses — nasal decolonisation and wound/skin treatment. Only the topical skin/wound use is dosed above, because that is the only product in the fetched bundle (Bactroban 2% Cream) and both fetched labels bar intranasal use of it. || DURATION AND REVIEW, §4.2 verbatim: 'Patients not showing a clinical response within 3 to 5 days should be re-evaluated. The duration of treatment should not exceed 10 days.' That is a duration ceiling, not a dose ceiling — the label states no maximum quantity, body-surface area or daily amount, so maxDose is deliberately left empty rather than guessed. || STRENGTH, US §3 verbatim: 'Mupirocin cream USP, 2% is a white to off white cream that contains 20 mg (2% w/w) of mupirocin per gram in an oil-and water-based emulsion, supplied in 15-gram and 30-gram tubes.' || DO NOT DILUTE OR MIX, §4.2 verbatim: 'Do not mix with other preparations, as there is a risk of dilution, resulting in a reduction in the antibacterial activity and potential loss of stability of the mupirocin in the cream.' US §2 adds: 'Do not apply mupirocin cream concurrently with any other lotions, creams or ointments.' || ELDERLY: §4.2 gives the elderly the same regimen as adults; US §8.5 cross-check: 'In 2 adequate and well-controlled trials, 30 subjects older than 65 years were treated with mupirocin cream. No overall difference in the efficacy or safety of mupirocin cream was observed in this patient population when compared with that observed in younger patients.' || §4.5, verbatim: 'No interaction studies have been performed.'

Paediatric dose

Route: Topical (cutaneous) cream to the affected area — NOT for intranasal, ophthalmic or other mucosal use
Frequency: 3 times a day for up to 10 days
dosePerKg is null because this is a topical cream applied by lesion area, not by body weight: the label states no milligram-per-kilogram figure anywhere, and no weight bands. concentration is null because the product is a cream quantified per gram (20 mg mupirocin per gram, US §3), not a liquid with a milligram-per-millilitre strength. AGE RANGE, §4.2 verbatim: 'Adults/children >= 1 year/elderly 3 times a day for up to 10 days, depending on the response.' LOWER AGE BAR, §4.2 verbatim: 'Children < 1 year — The safety and efficacy of Bactroban Cream in children aged less than one year have not yet been established. No data are available.' US cross-check §8.4 states a different lower bound — 'The safety and effectiveness of mupirocin cream have been established in the age-groups 3 months to 16 years' — so UK and US labelling disagree on the minimum age; the UK SPC bound (1 year) is the one applied here. Application method is the same as for adults: 'A thin layer of cream should be applied to the affected area with a piece of clean cotton wool or gauze swab.' Verify any under-18 use against a current children's formulary. This is the skin/wound cream only — no paediatric nasal-decolonisation regimen is published, because no nasal product is in this bundle.

Dose adjustments

Renal

§4.2 Renal impairment, verbatim: 'No dosage adjustment is necessary.'

Hepatic

§4.2 Hepatic impairment, verbatim: 'No dosage adjustment is necessary.'

Dose independently re-sourced from UK Summary of Product Characteristics (SPC) via the eMC; US FDA prescribing information (openFDA / DailyMed) — cross-check; US labelling may differ from UK — clinician-reviewed. Always confirm against the product SmPC and your local formulary before prescribing.

Contraindications

  • §4.3, verbatim and complete — the only contraindication in the UK label: 'Hypersensitivity to mupirocin or to any of the excipients listed in section 6.1.' (US §4 agrees: 'Known hypersensitivity to mupirocin or any of the excipients of mupirocin cream.')
  • Not a §4.3 contraindication but an absolute route bar (§4.4): 'Bactroban Cream formulation is not suitable for ophthalmic use and intranasal use. Avoid contact with the eyes.'
  • Not a §4.3 contraindication but a §4.4 stop rule: 'Should a possible sensitisation reaction or severe local irritation occur with the use of Bactroban Cream, treatment should be discontinued, the product should be washed off and appropriate therapy instituted.'
  • Not a §4.3 contraindication but a §4.2 handling bar: 'Do not mix with other preparations, as there is a risk of dilution, resulting in a reduction in the antibacterial activity and potential loss of stability of the mupirocin in the cream.'
  • Excipient cautions, §4.4 verbatim: 'Bactroban Cream contains cetyl alcohol and stearyl alcohol. These inactive ingredients may cause local skin reactions (e.g. contact dermatitis). Bactroban Cream also contains 153 mg benzyl alcohol in each 15 g tube. This inactive ingredient may cause mild local irritation.'

Side effects

  • Common (>=1/100 and <1/10), §4.8 verbatim: 'Skin and subcutaneous tissue disorders — Application site hypersensitivity reactions including urticaria, pruritus, erythema, burning sensation, contact dermatitis, rash'
  • Very rare (<1/10,000), §4.8 verbatim: 'Immune system disorders — Systemic allergic reactions including anaphylaxis, generalised rash, urticaria and angioedema'
  • §4.8, verbatim: 'Skin dryness and erythema have been reported in irritancy studies in volunteers.'
  • §4.4, verbatim: 'As with other antibacterial products, prolonged use may result in overgrowth of non-susceptible organisms.'
  • §4.4, verbatim: 'Pseudomembranous colitis has been reported with the use of antibiotics and may range in severity from mild to life-threatening... Although this is less likely to occur with topically applied mupirocin, if prolonged or significant diarrhoea occurs or the patient experiences abdominal cramps, treatment should be discontinued immediately and the patient investigated further.'
  • US cross-check §6.1 (US label, list incomplete — truncated at the source-fetch limit): 'The following adverse reactions were reported by at least 1% of subjects in connection with the use of mupirocin cream in clinical trials: headache (1.7%), rash (1.1%), and nausea (1.1%).' Reactions reported in fewer than 1% included abdominal pain, burning at application site, cellulitis, dermatitis, dizziness, pruritus and secondary wound [text truncated at source].

Monitoring

  • Clinical response — §4.2, verbatim: 'Patients not showing a clinical response within 3 to 5 days should be re-evaluated. The duration of treatment should not exceed 10 days.'
  • Local tolerance — §4.4: watch for a sensitisation reaction or severe local irritation; if either occurs, stop treatment, wash the product off and institute appropriate therapy.
  • Diarrhoea or abdominal cramps during or after treatment — consider Clostridioides difficile-associated diarrhoea and investigate further (§4.4; US §5.4).
  • Prolonged use — §4.4: watch for overgrowth of non-susceptible organisms (US §5.5 adds 'including fungi').
  • No laboratory monitoring is required by this label for topical use, and none is asserted here.

Clinical monograph

How it works

It reversibly inhibits bacterial isoleucyl-tRNA synthetase, halting protein synthesis and giving activity chiefly against staphylococci and streptococci.

Prescribing in practice

  • Reserve mupirocin for targeted use such as MRSA decolonisation and limited courses, because prolonged or widespread use drives resistance; it is not for routine prophylaxis over large burns.
  • Use the correct product for the site — the nasal preparation for the anterior nares and the cutaneous preparation for skin and wounds — and avoid contact with the eyes.
  • The polyethylene glycol skin base can be absorbed and is a concern when applied to extensive open wounds in patients with renal impairment.

Monitoring

Monitor the treated site for resolution and local irritation, and where used for decolonisation follow local screening protocols to confirm clearance.

Counselling the patient

  • Use this only at the site and for the duration advised to avoid resistance.
  • Use the nasal product inside the nose and the skin product on the skin as directed.
  • Report any rash or irritation where it is applied.

Evidence & guidelines

Mupirocin nasal decolonisation is supported by infection-prevention guidance for staphylococcal carriage and MRSA control.

Reference: NICE NG118 MRSA; PHE MRSA Decolonisation Guidelines; Drug verified in RxNorm (NLM); confirm dosing against the manufacturer SPC (eMC). Verify against your local formulary and current prescribing references before prescribing. The structured dose values shown have been reviewed by a clinician. Monograph status: clinician-reviewed (2026-07-04).

Related

Curated clinical cross-links plus same-class fallbacks.

Calculators
Pathways