Time Course of Nasal Decolonizing Agents

Studies of nasal decolonization agents that report on time course (SR articles)

 * 1983 (maybe) Dacre, Emmerson & Jenner
 * 1986 Casewell and Hill - mupirocin ointment RCT
 * 1991 Reagan, Doebbeling, Pfaller et all - mupirocin ointment RCT
 * 1991 Holten, Nicolle, Diley, Bernstein - mupirocin ointment haemodialysis

1983 Dacre, Emmerson & Jenner
Check to see if they report anything on time.

1986 Casewell and Hill
In 1986, Casewell and Hill published an RCT of 2% mupirocin ointment "Elimination of nasal carriage of Staphylococcus aureus with mupirocin ('pseudomonic acid') - a controlled trial".

In this trial, 52 healthy persistent (two positive nasal swabs a week apart + a thrid confirmatory swab) carriers were treated with 2% mupirocin ointment (n=36) or placebo (n=18) in their anterior nares 4x/day for 5 days. After two days, S. aureus had been eliminated in all persistent carriers in the treatment group.

Nasal swabs were taken after 1, 4, 8, and 40 applications (day 0, 1, 2, and 5). After elimination from the nose, swabs were also taken from the nose, perineum, axillae and wrists. Follow-up was taken two days after completion of the course (day 7), once per week for five weeks and then at least onve every four weeks until the subject was unable.

If a subject was recolonized within 30 days of placebo or treatment, then subject was treated with the opposite treatment.

Results and Conclusions:
Following application of mupirocin, nasal carriage of S. aureus was eliminate quickly in all volunteers (within 2 days). At 22 weeks, 56% of subjects were culture negative for S. aureus (although the number of subjects loss to follow-up wasn't reported). Skin carriage at the wrist or perineum disappeared immediately following treatment. There was also a reduction in other nasal flora following mupirocin treatment.

These results suggested that mupirocin was a good candidate for the eradication of nasal S. aureus carriage and that the length of treatment required to be effective is likely shorter than 5 days.

1991 Reagan, Doebbeling, Pfaller et al
In 1991, Reagan et al published "Elimination of coincident Staphylococc us a ure us nasal and hand carriage with intranasal application of mupirocin  calci um ointment" in Annals of Internal Medicine.

This was a placebo-controlled, do uble-blinded  RCT of m upirocin calci um ointment in 68 nasal carriers of S. a ure us ( helathy health care workers). Participants received m upirocin or placebo 2x per day for 5 days and c ult <span style="color:rgb(68,68,68);font-family:HelveticaNeue,HelveticaNeue,Helvetica,sans-serif;font-size:13px;">ures of the hands the the anterior nares were taken at 72 ho <span style="color:rgb(68,68,68);font-family:HelveticaNeue,HelveticaNeue,Helvetica,sans-serif;font-size:13px;">urs. The anterior nares were also c <span style="color:rgb(68,68,68);font-family:HelveticaNeue,HelveticaNeue,Helvetica,sans-serif;font-size:13px;">ult <span style="color:rgb(68,68,68);font-family:HelveticaNeue,HelveticaNeue,Helvetica,sans-serif;font-size:13px;">ured at 1, 2, 4 and 12 weeks post therapy.

Results and Conclusions:
M<span style="color:rgb(68,68,68);font-family:HelveticaNeue,HelveticaNeue,Helvetica,sans-serif;font-size:13px;">upirocin decreased S. a <span style="color:rgb(68,68,68);font-family:HelveticaNeue,HelveticaNeue,Helvetica,sans-serif;font-size:13px;">ure <span style="color:rgb(68,68,68);font-family:HelveticaNeue,HelveticaNeue,Helvetica,sans-serif;font-size:13px;">us nasal carriage at each time point. <span style="color:rgb(68,68,68);font-family:HelveticaNeue,HelveticaNeue,Helvetica,sans-serif;font-size:13px;">The study concluded that mupirocin calcium ointment in paraffin is safe and effective at eliminating nasal carriage in S. aureus <span style="color:rgb(68,68,68);font-family:HelveticaNeue,HelveticaNeue,Helvetica,sans-serif;font-size:13px;">in healthy persons.

<span style="color:rgb(68,68,68);font-family:HelveticaNeue,HelveticaNeue,Helvetica,sans-serif;font-size:13px;">The study results supported the current belief that S. aureus carrier status is generally stable across periods of several months or years. In this study, 82% of those carriers treated with placebo remained carriers of the same S. aureus strain at the end of the 3-month study period.

The clearance of S. aureus from the hands of carriers was observed and Reagan et al notes that this perhaps explains the decrease in S. aureus infections among haemodialysis patients.

1991 Holten, Nicolle, Diley, Bernstein
In 1991, Holten et al conducted a pilot study to determine:

"(a) the efficacy of mupirocin in eliminating nasal carriage in a dialysis population and (b) the length of time patients remained free of nasal S. aureus carriage following treatment."