Mupirocin side effects and how to avoid them

Common side effects | Side effects timeline | Interactions | Safety measures | How to avoid side effects | How to treat side effects

Mupirocin is a generic topical antibiotic that is prescribed as a cream or ointment to treat bacterial skin infections caused by streptococcal and staphylococcal bacteria. The drug works by both killing bacteria and preventing their growth. Mupirocin cream and some versions of mupirocin ointment are prescribed for bacterial infections of wounds, but only the ointment is approved by the Food and Drug Administration (FDA) for impetigo. There are no brand-name versions on the market, though mupirocin was originally sold under the brand name Centany. A nasal mupirocin calcium ointment that was once sold under the brand name Bactroban is no longer available in the United States. People who are prescribed mupirocin will typically apply the ointment or cream to the affected skin three times a day. Side effects are rare, but they may include headaches, rashes, and nausea.

Common side effects of mupirocin

Most people will not experience side effects when using mupirocin. In those that do, the effects are usually mild or moderate.

In clinical trials, only 8% of participants complained of side effects. According to the drug label, the most common side effects of mupirocin cream are headache, skin rash, and nausea. Other reported but less common adverse reactions include:

• Abdominal pain
• Burning
• Dermatitis
• Skin infections
• Dizziness
• Itching
• Secondary infection of the wound
• Mouth ulcers
• Bleeding or pain due to eczema
• Hives
• Dry skin

Serious side effects of mupirocin

When applied to the skin, very little mupirocin is absorbed into the body, so serious side effects are rare. They include:

• Severe allergic reactions
• Secondary infections
• Clostridium difficile (C. difficile)

Mupirocin and C. diff

All antibiotics can cause a C. difficile overgrowth in the colon, but it is a rare side effect of topical antibiotics like mupirocin. Less than 1% of mupirocin enters the bloodstream, so the system-wide exposure is minimal. Still, a C. difficile infection is possible. The signature symptom of a C. difficile infection is severe diarrhea and abdominal bloating. These symptoms usually occur within a week of antibiotic treatment but can appear up to two months after mupirocin has been discontinued. If watery or bloody diarrhea occurs when taking antibiotics or in the weeks after taking them, seek immediate medical attention.

Mupirocin and eczema

Mupirocin is commonly prescribed for secondary infections associated with eczema. In clinical trials, some trial participants reported problems when applying mupirocin cream to the skin affected by eczema, particularly bleeding and pain.

Mupirocin and allergic reactions

The most likely severe side effect of mupirocin is a severe allergic reaction. Again, very little of the medicine actually enters the body, but this could be enough to set off a severe reaction. Several types of reactions have been reported in people using mupirocin, including anaphylaxis, facial swelling, and a general rash. If severe symptoms, such as trouble breathing, facial swelling, or sudden drop in blood pressure, occur when using mupirocin, seek immediate medical attention. 

How soon do mupirocin side effects start?

Site reactions like itching may happen immediately upon applying mupirocin to the skin. Others, like rash, redness, burning, itching, irritation, or pain, could start soon after applying it, if not immediately. Headache and nausea are also experienced early after starting mupirocin. Delayed side effects include secondary infections and mouth sores. Though rare, C. difficile diarrhea could take as long as two months after mupirocin treatment to appear, though it usually happens within a week of finishing antibiotic treatment.

How long do mupirocin side effects last?

People experiencing adverse effects of mupirocin can expect them to end when treatment ends. Treatment for secondary infections typically lasts ten days. Impetigo treatment can last as little as seven days and as long as 14 days.

What are the long-term side effects of mupirocin?

Though very rare, a C. difficile infection (CDI) can happen days or weeks after using mupirocin cream. A severe C. difficile infection could cause long-term or lifelong complications. Because so little mupirocin is absorbed into the body, it isn’t an antibiotic that’s most likely to cause C. diff.

Mupirocin interactions

The mupirocin drug label doesn’t list any drug interactions. Although no drug interactions have been reported, tell your healthcare provider if you’re taking any other medications when starting treatment with mupirocin.

Safety measures while using mupirocin

Boxed warning

The FDA mandates boxed warnings for drugs that have a significant risk of severe side effects. The FDA has not attached a boxed warning to mupirocin products. 

Precautions

Mupirocin is only contraindicated for people who have had allergic reactions to mupirocin. 

Children

The FDA has determined that mupirocin topical ointment is safe and effective in children as young as 2 months old, and mupirocin topical cream is safe for children as young as 3 months old. 

Pregnancy

There are only a few studies on the safety of mupirocin use during pregnancy. However, healthcare providers consider it safe to use during pregnancy because less than 1% of the drug is absorbed into the bloodstream when applied to the skin.

Breastfeeding

Absorption of topical mupirocin is minimal, so healthcare providers do not typically refrain from prescribing mupirocin cream or ointment to women who are breastfeeding. There hasn’t been enough research on the risk to infants when using this medication during breastfeeding. Healthcare providers advise mothers to prevent the baby’s skin from contacting any part of the mother’s skin where mupirocin has been applied.

Dependence

Mupirocin use does not cause physical or psychological dependence. Discontinuing mupirocin will not cause withdrawal symptoms.

Overdose

A mupirocin overdose is not considered dangerous since so little of the drug is absorbed into the bloodstream when applied to the skin. However, swallowing mupirocin cream or ointment is a different matter. In that case, call 911 or seek emergency treatment. 

How to avoid mupirocin side effects

Children and adults using mupirocin don’t often have side effects from it. When they do, those effects are often mild. Even so, there are ways to reduce or minimize the risk of mupirocin side effects:

• Give the doctor a complete medical history. Just to be safe, make sure your prescribing healthcare provider knows about any past and present medical conditions as well as any prescription drugs, over-the-counter remedies, and dietary supplements you’re taking.
• Take mupirocin as directed. Follow all of the dosing instructions given by your healthcare provider. Even if the skin improves, continue applying mupirocin for the full length of treatment to cure the infection completely. Only apply it to affected areas of the skin.
• Don’t apply mupirocin with your hands. Apply mupirocin with a cotton swab or gauze pad to ensure that none of the medicine gets on your hands or fingers. This will minimize exposure to the drug. 
• Don’t use other medications on the same area of the treated skin. Avoid putting other topical medications, such as non-prescription anti-itch remedies, on the treated area unless instructed by a healthcare professional.
• Don’t apply mupirocin to mucus membranes or the eyes. If mupirocin cream gets in the mouth, nose, or eyes, rinse the area with water.
• Dress the treated area with sterile gauze. A dressing isn’t required after applying mupirocin to the skin, but it will prevent accidental exposure to others. This is especially important for infants. Do not use a bandage or any other covering that will not allow airflow to the affected area.
• Keep the mupirocin tube out of reach of children. Accidental ingestion of mupirocin is more likely to cause side effects and severe problems. The tube does not have a childproof cap, so make sure children have no possible access to the medicine.

How to treat side effects of mupirocin

Call your healthcare provider if you experience side effects. If you have signs of an allergic reaction, stop using the medicine and get medical help. While a C. difficile infection is rare, side effects like watery or bloody diarrhea could show up weeks after mupirocin treatment has ended. If that happens, get immediate medical attention.

Bottom line: Is mupirocin safe?

Healthcare providers consider mupirocin to be a safe and well-tolerated medication. As a topical antibiotic, only minimal amounts of the drug are absorbed into the body. Possible side effects are not very common and tend to be mild or moderate if they do occur. Severe side effects are rare and mainly limited to allergic reactions. Mupirocin does not interact with other drugs or supplements. Accidental ingestion is possible, so this medicine needs to be kept well out of reach of children and pets.