Mupirocin Cream Is as Effective as Oral Cephalexin in the Treatment of Secondarily Infected Wounds

Journal of Family Practice, Dec, 1998 by Stephen J. Kraus, Lawrence J. Eron, Gerald W. Bottenfield, Margaret A. Drehobl, William D. Bushnell, Michael A. Cupo

ADVERSE EXPERIENCES

Sixty of 706 patients (8.5%) reported 70 adverse experiences related or possibly related to the study medication (27 of 357 patients in the mupirocin group [7.6%] and 33 of 349 patients in the cephalexin group, [9.5%]; P = .42 between groups). The most frequently reported related or possibly related adverse experiences in both treatment groups were headache, diarrhea, and nausea, reported by 2.0%, 1.1%, and 1.1%, respectively, of patients in the mupirocin calcium cream group and by 1.1%, 2.3%, and 1.1%, respectively, of patients in the cephalexin group. No adverse experiences related or possibly related to study medication were severe in intensity. Ten patients in the mupirocin group (2.8%) and 7 in the cephalexin group (2.0%) were withdrawn because of adverse experiences. Adverse experiences believed related or possibly related to study medication that led to patient withdrawal were abdominal pain, nausea, earache, secondary wound infection, dermatitis, and rash in the mupirocin group and anorexia, diarrhea (3 patients), and urticaria in the cephalexin group.

PATIENT ACCEPTANCE

Of the patients completing the end of treatment survey, 484 (72%) preferred topical therapy and 181 (27%) preferred oral therapy. Six hundred sixty-four patients (99%) answered that the cream was easy to apply. Reponses were similar for patients in each of the treatment groups separately.

DISCUSSION

These large, multicenter studies demonstrated that topical antibiotic treatment with mupirocin cream is as effective as systemic treatment with oral cephalexin for secondarily infected wounds. Both agents resulted in a greater than 90% success rate for evaluable patients (83% for intention-to-treat patients). Therefore, the choice of regimen can be based on the potential for adverse effects and patient convenience. In these studies almost all patients felt that the topical treatment was easy to apply. Two thirds of patients indicated that they preferred topical treatment over oral treatment.

Mupirocin has demonstrated activity against many multidrug-resistant staphylococci, including methicillin. resistant strains.[1,6] In these studies, resistance to the antimicrobial regimens was not detected from pretherapy isolates, and did not develop during therapy. Resistance of staphylococci to mupirocin has been reported in clinical isolates, usually with long-term (more than 10 days) use.[7] In one multicenter survey of 8220 isolates of staphylococci in the United Kingdom, .3% of S aureus and 3% of coagulase negative staphylococci were mupirocin resistant.[8] A study of 1309 S aureus isolates from hospital personnel in the United States demonstrated a 1% resistance rate.[9] Intermittent or short-term use of mupirocin is unlikely to present a high risk of development of resistance.

One difficulty in conducting trials of secondarily infected wounds is determination of whether a wound is infected. In this trial we relied on the subjective assessment of the investigator; however, objective criteria were also considered. To be enrolled, the patient had to have a minimum SIRS score and the presence of white blood cells in the wound by Wright's stain. We believe these criteria have improved the validity of the data generated.