Eradication of methicillin-resistant Staphylococcus aureus (MRSA) throat carriage: a randomised trial comparing topical treatment with rifampicin-based systemic therapy

• Published in: International journal of antimicrobial agents Vol. 51; no. 4; pp. 642 - 645
• Main Authors: Lindgren, Anna-Karin, Nilsson, Anna C., Åkesson, Per, Gustafsson, Eva, Melander, Eva
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier B.V 01.04.2018
• Subjects: Administration, Oral; Administration, Topical; antibiotic resistance; chlorhexidine; Chlorhexidine - therapeutic use; clindamycin; Clindamycin - administration & dosage; Clindamycin - therapeutic use; Clinical Medicine; Drug Combinations; Eradication; households; Humans; hygiene; Infectious Medicine; Infektionsmedicin; Klinisk medicin; Medical and Health Sciences; Medicin och hälsovetenskap; methicillin; methicillin-resistant Staphylococcus aureus; Methicillin-Resistant Staphylococcus aureus - drug effects; MRSA; Mupirocin - administration & dosage; Mupirocin - therapeutic use; nose; patients; perineum; pharynx; rifampicin; Rifampin - administration & dosage; Rifampin - therapeutic use; risk reduction; Staphylococcal Skin Infections - drug therapy; Sulfamethizole - administration & dosage; Sulfamethizole - therapeutic use; sulfamethoxazole; therapeutics; throat; Throat carriage; trimethoprim; Trimethoprim - administration & dosage; Trimethoprim - therapeutic use; washing; Eradication; Throat carriage; MRSA
• ISSN: 0924-8579; 1872-7913; 1872-7913
• DOI: 10.1016/j.ijantimicag.2017.08.021

•Rifampicin-based systemic antibiotics plus topical mupirocin decolonised 61% of study subjects at 6-month follow-up.•For eradication of an extranasal site, this success rate is considered high.•Study subjects receiving topical mupirocin only were not decolonised, with only 12% negative at 6-month follow-up.•Based on previous studies, this might reflect spontaneous decolonisation.•This indicates that throat carriers should not receive mupirocin only, which is the standard protocol in many institutions. Eradication of methicillin-resistant Staphylococcus aureus (MRSA) colonisation may prevent transmission of strains between patients and reduces the risk of clinical infection. Colonisation of the throat is associated with prolonged carriage and is more difficult to eradicate. An open randomised study was conducted to evaluate two eradication protocols. Patients with pharyngeal carriage of MRSA were enrolled at six Swedish centres during 4 years. One treatment group received oral rifampicin and either clindamycin or trimethoprim/sulfamethoxazole (SXT) for 7 days in combination with nasal mupirocin. Patients in the other group were treated with nasal mupirocin only. Patients in the same household were randomised together. Both groups followed a hygiene protocol including chlorhexidine washing. Cultures from the nares, perineum and throat were taken at baseline and then at 2 weeks, 2 months and 6 months after the end of treatment. A total of 28 patients received rifampicin-based systemic antibiotics and 24 subjects received mupirocin only. At follow-up 6 months after the end of treatment, 61% of patients and 50% of households in the systemic antibiotics group had culture results negative for MRSA. Significantly less patients (12%) and households (10%) became decolonised in the group receiving topical treatment only. A combination of rifampicin and either clindamycin or SXT was more effective in eliminating pharyngeal MRSA carriage compared with topical treatment with mupirocin only.