S. aureus decolonization agents

Systematic treatments:

 * 1) Oral rifampicin has been reported to be effective in haemodialysis patients [Yu 1986]
 * 2) *Generally, there is initial successful decolonization, but frequent rifampicin resistance appears during monotherapy [Yu 1986, Sande 1975]
 * 3) *Cloxacillin and trimethoprim-sulfamethoxazole are most frequently used in combination with rifampicin.
 * 4) Oral ciprofloxacin, with and without rifampin, have been reported to be effective at eliminating S. aureus nasal carriage, but increased minimum inhibitory concentrations to ciprofloxacin have been noted in up to 33% of patients.
 * 5) Clindamycin has also been used.
 * 6) *Reliably eradicates carriage [Chow 1989]
 * 7) Oral cloxacillin
 * 8) *interrupted carriage for < 2 weeks before relapse [Chow 1989]
 * 9) Oral Tetracycline
 * 10) *interrupted carriage for < 2 weeks before relapse [Chow 1989]
 * 11) Ohter

Topical treatments:

 * 1) Topical penicillin was ineffective in eradicating S. aureus over periods of one to three months [Gould 1955].
 * 2) Topical vancomycin was ineffective in eradicting S. aureus over periods of one to three months [Bryan et al, 1980].
 * 3) *interrupted carriage for < 2 weeks before relapse [Chow 1989]
 * 4) Topical bacitracin was not efficacious [Bryan et al, 1980]
 * 5) *interrupted carriage for < 2 weeks before relapse [Chow 1989]
 * 6) Topical gentimicin had short term efficacy [White  1964, Williams et al 1967], but there are concerns over selection of gentimicin resistance.
 * 7) *interrupted carriage for < 2 weeks relapse [Chow 1989]
 * 8) Other

Other treatments:

 * 1) Whole-body antiseptic wash
 * 2) Hexachlorophrene baths
 * 3) Replacement of nasal carriage with the less virulent 502A strain
 * 4) *Requires decolonization both hand and may still lead to disease
 * 5) Other

Systemic versus topical agents
Reagan notes in their 1991 RCT that there are several reasons to favour the use of a topical agent for decolonization:
 * 1) Relative safety compared to systemic approaches
 * 2) *Rifampicin and clindamycin are associated with toxicity
 * 3) Avoidance of development of resistance to drugs with important therapeutic roles
 * 4) Expense
 * 5) *Generally, systemic antibiotics are more expensive than topical treatments
 * 6) Other