February 13, 2016
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Bactroban Nasal

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Bactroban Nasal




CLINICAL PHARMACOLOGY

Mechanism Of Action

Mupirocin is an antibacterial drug [see Microbiology].

Pharmacokinetics

Absorption

Following single or repeated intranasal applications of 0.2 grams of BACTROBAN nasal ointment 3 times daily for 3 days to 5 healthy adult male subjects, no evidence of systemic absorption of mupirocin was demonstrated. The dosage regimen used in this trial was for pharmacokinetic characterization only; see DOSAGE AND ADMINISTRATION for proper clinical dosing information.

In this trial, the concentrations of mupirocin in urine and of monic acid in urine and serum were below the limit of determination of the assay for up to 72 hours after the applications. The lowest levels of determination of the assay used were 50 ng/mL of mupirocin in urine, 75 ng/mL of monic acid in urine, and 10 ng/mL of monic acid in serum. Based on the detectable limit of the urine assay for monic acid, one can extrapolate that a mean of 3.3% (range: 1.2% to 5.1%) of the applied dose could be systemically absorbed from the nasal mucosa of adults.

The effect of concurrent application of BACTROBAN nasal ointment with other intranasal products has not been studied [see DOSAGE AND ADMINISTRATION].

Elimination

In a trial conducted in 7 healthy adult male subjects, the elimination half-life after intravenous administration of mupirocin was 20 to 40 minutes for mupirocin and 30 to 80 minutes for monic acid.

Metabolism: Following intravenous or oral administration, mupirocin is rapidly metabolized. The principal metabolite, monic acid, demonstrates no antibacterial activity.

Excretion: Monic acid is predominantly eliminated by renal excretion.

Special Populations

Pediatrics: The pharmacokinetic properties of mupirocin following intranasal application of BACTROBAN nasal ointment have not been adequately characterized in neonates or other children younger than 12 years, and in addition, the safety and efficacy of the product in children younger than 12 years have not been established.

Renal Impairment: The pharmacokinetics of mupirocin have not been studied in individuals with renal insufficiency.

Microbiology

Mupirocin is an antibacterial agent produced by fermentation using the organism Pseudomonas fluorescens.

Mechanism of Action

Mupirocin inhibits bacterial protein synthesis by reversibly and specifically binding to bacterial isoleucyl-transfer RNA (tRNA) synthetase.

Mupirocin is bactericidal at concentrations achieved by topical intranasal administration. Mupirocin is highly protein bound ( > 97%), and the effect of nasal secretions on the minimum inhibitory concentrations (MICs) of intranasally applied mupirocin has not been determined.

Mechanism of Resistance

When mupirocin resistance occurs, it results from the production of a modified isoleucyl-tRNA synthetase, or the acquisition of, by genetic transfer, a plasmid mediating a new isoleucyl-tRNA synthetase. High-level plasmid-mediated resistance (MIC ≥ 512 mcg/mL) has been reported in increasing numbers of isolates of S. aureus and with higher frequency in coagulase-negative staphylococci. Mupirocin resistance occurs with greater frequency in methicillin-resistant than methicillin-susceptible staphylococci.

Cross Resistance

Due to its mode of action, mupirocin does not demonstrate cross resistance with other classes of antimicrobial agents.

Susceptibility Testing

High-level mupirocin resistance ( ≥ 512 mcg/mL) may be determined using standard disk diffusion or broth microdilution tests1,2. The significance of these results, with regard to decolonization regimens, should be evaluated at each medical facility, in conjunction with laboratory, medical, and infection control staff.

Correlation of BACTROBAN nasal ointment in vitro activity and MRSA nasal decolonization has been demonstrated in clinical trials [see Clinical Studies].

Clinical Studies

All adequate and well-controlled trials of this product were vehicle-controlled; therefore, no data from direct, head-to-head comparisons with other products are available. The safety and effectiveness of applications of this medication for greater than 5 days have not been established. There are no human clinical or pre-clinical animal data to support the use of this product in a chronic manner or in manners other than those described in this prescribing information.

In clinical trials, 210 domestic (US) and 2,130 foreign adult subjects received BACTROBAN nasal ointment. Greater than 90% of subjects in clinical trials had eradication of nasal colonization 2 to 4 days after therapy was completed. Approximately 30% recolonization was reported in 1 domestic trial within 4 weeks after completion of therapy. These eradication rates were clinically and statistically superior to those reported in subjects in the vehicle-treated arms of the adequate and well-controlled trials. Those treated with vehicle had eradication rates of 5% to 30% at 2 to 4 days post-therapy with 85% to 100% recolonization within 4 weeks.

REFERENCES

1. Clinical and Laboratory Standards Institute (CLSI). Performance Standards for Antimicrobial Susceptibility Testing; 25th Informational Supplement. CLSI document M100-S22. CLSI, 950 West Valley Rd., Suite 2500, Wayne, PA 19087, 2015.

2. Patel J, Gorwitz RJ, et al. Mupirocin Resistance. Clinical Infectious Diseases. 2009; 49(6); 935-41.

Last reviewed on RxList: 12/26/2015
This monograph has been modified to include the generic and brand name in many instances.

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