Treatment of Staphylococcus Infection in the Nares

Introduction to Treatment

The Infectious Diseases Society of America recommends treating active staph infection in the nares with mupirocin 2% ointment applied to both anterior nares twice daily for 5-10 days, combined with appropriate systemic antibiotics if there are signs of invasive infection 1, 2

Active infection presents with purulent drainage, crusting, pain, erythema, or systemic signs, requiring antimicrobial treatment 1

Systemic antibiotics should be added if there is extensive surrounding cellulitis, fever, or systemic manifestations of infection 1, 4
For MSSA infections with systemic involvement, the American College of Physicians recommends nafcillin 1-2 g IV every 4-6 hours (adults) or 50 mg/kg/dose (pediatrics) 1
For MRSA infections with systemic involvement, the Infectious Diseases Society of America recommends vancomycin, linezolid, daptomycin, or ceftaroline based on severity 1
The duration of systemic therapy is typically 5-7 days depending on clinical response 1

Decolonization should only be pursued in patients with documented recurrent staph skin infections despite optimized hygiene, or ongoing household transmission—not for simple colonization 2, 3
The Centers for Disease Control and Prevention recommends mupirocin 2% ointment to anterior nares twice daily for 5-10 days as part of decolonization protocol 2, 3
Add chlorhexidine gluconate 2% body wash daily for 5-14 days, OR dilute bleach baths for 15 minutes twice weekly for up to 3 months 2, 3

The American Academy of Pediatrics recommends evaluating and treating symptomatic household contacts for active infection first 2, 3
Consider decolonization of asymptomatic household contacts only when ongoing transmission is documented despite hygiene measures 2, 3
Treating both patient and household contacts together results in fewer recurrences than treating the patient alone 3

The American College of Physicians advises against using mupirocin for simple nasal trauma or cuts without signs of infection—this promotes resistance without clinical benefit 5
The Infectious Diseases Society of America recommends avoiding routine surveillance cultures post-decolonization in the absence of active infection 2, 3
High-level mupirocin resistance has been reported; prolonged or indiscriminate use should be avoided 3
The Centers for Disease Control and Prevention notes that recolonization is common after decolonization therapy, occurring in 40-60% of patients within 3 months 3
Do not use hexachlorophane in children under 2 months due to neurological complications 2
Mupirocin effectively reduces nasal colonization but has not conclusively been shown to prevent infections in community settings 3