Carriers face high risk of death from methicillin-resistant Staphylococcus aureus, or MRSA, infection, according to a study researchers Rupak Datta and Dr. Susan S. Huang published in "Clinical Infectious Disease" in July 2008. While health care providers may attempt to eradicate a MRSA colonization using various treatment regimens, or may choose to treat an entire household if necessary, they may also elect not to treat at all, writes nurse practitioner Karen E. Preston in the July 2010 issue of "Advance for Nurse Practitioners."
Mupirocin Nasal
Colonization of MRSA in the nose presents the most significant risk factor for developing a MRSA infection, according to Preston. Mupirocin eradicates MRSA from the nose. Health care providers rely on mupirocin as the nasal treatment of choice, which has led to MRSA resistance to the drug. Mupirocin offers 93 percent effectiveness initially, but at 90-days post-treatment, effectiveness drops to 61 percent, according to Preston. According to a position paper by Dr. Andrew E. Simor and colleagues in the January-February 2004 issue of "Canadian Journal of Infectious Disease," mupirocin used for five days will provide 74 percent eradication at 90 days post-treatment. T. Coates and colleagues published a review in the May 2009 issue of "Journal of Antimicrobial Chemotherapy" that says 81.5 to 100 percent decolonization occurs immediately after treatment with mupirocin.
Rifampin Regimens
Health care providers use rifampin in combination with other oral antibiotics for decolonization of MRSA and only rarely by itself. According to Simor and colleagues, the most effective drugs in combination with rifampin include novobiocin, minocycline, trimethoprim-sulfamethoxazole and ciprofloxacin. These combinations provide 67 percent, 50 percent, 40 percent and 30 percent eradication, respectively.
Multi-Drug Regimens
Colonization most often occurs in two or more areas of the body, leading to the necessity of multi-drug regimens. Preston states that a combination of body wash, nasal ointment and two oral antibiotics, rifampin and doxycycline, provides 92 percent eradication. This falls to 74 percent by 90 days post-treatment. Dr. Scott K. Fung and colleagues studied three multi-drug regimens. According to their report in the September-October 2002 issue of "Canadian Journal of Infectious Disease," the regimens included various combinations of mupirocin, rifampin, doxycycline and trimethprim-sulfamethoxazole. The eradication rate was 98 percent initially and remained as high as 88 percent one year post-treatment.
References
- "Clinical Infectious Disease"; Risk of Infection and Death Due to Methicillin-Resistant Staphylococcus Aureus in Long Term-Carriers; Rupak Datta; Jul. 2008
- "Advance for Nurse Practitioners"; Decolonization of MRSA Carriers; Karen E. Preston; Jul. 2010
- "Canadian Journal of Infectious Disease"; Combined Topical and Oral Antimicrobial Therapy for the Eradication of Methicillin-Resistant Staphylococcus Aureus (MRSA) Colonization in Hospitalized Patients; Scott K. Fung; Sept.-Oct. 2002
- "Canadian Journal of Infectious Disease"; The Management of Infection and Colonization due to Methicillin-Resistant Staphylococcus Aureus: A CIDS/CAMM Position Paper; Andrew E. Simor; Jan.-Feb. 2004
- "Journal of Antimicrobial Chemotherapy"; Nasal Decolonization of Staphylococcus Aureus With Mupirocin: Strengths, Weaknesses and Future Prospects; T. Coates; May 2009
