Source: Medicines & Healthcare Products Regulatory Agency (GB) Revision Year: 2016 Publisher: Beecham Group plc, 980 Great West Road, Brentford, Middlesex TW8 9GS Trading as: GlaxoSmithKline UK, Stockley Park West, Uxbridge, Middlesex, UB11 1BT
Pharmacotherapeutic group: Antibiotics and chemotherapeutics for dermatological use
ATC code: D06AX09
Mupirocin is a novel antibiotic produced through fermentation by Pseudomonas fluorescens. Mupirocin inhibits isoleucyl transfer-RNA synthetase, thereby arresting bacterial protein synthesis.
Mupirocin has bacteriostatic properties at minimum inhibitory concentrations and bactericidal properties at the higher concentrations reached when applied locally.
Low-level resistance in staphylococci is thought to result from point mutations within the usual staphylococcal chromosomal gene (ileS) for the target isoleucyl tRNA synthetase enzyme. High-level resistance in staphylococci has been shown to be due to a distinct, plasmid encoded isoleucyl tRNA synthetase enzyme.
Intrinsic resistance in Gram negative organisms such as the Enterobacteriaceae could be due to poor penetration of the outer membrane of the Gram-negative bacterial cell wall.
Due to its particular mode of action, and its unique chemical structure, mupirocin does not show any cross-resistance with other clinically available antibiotics.
The prevalence of acquired resistance may vary geographically and with time for selected species, and local information on resistance is desirable, particularly when treating severe infections. As necessary, expert advice should be sought when the local prevalence of resistance is such that the utility of the agent in at least some types of infection is questionable.
Commonly susceptible species:
Staphylococcus aureus*
Streptococcus spp.
Species for which acquired resistance may be a problem:
Methicillin-Resistant-Staphylococcus aureus (MRSA)
Methicillin-resistant coagulase-negative Staphylococci (MRCoNS)
Inherently resistant organisms:
Corynebacterium spp.
Micrococcus spp.
* Clinical efficacy has been demonstrated for susceptible isolates in approved clinical indications.
Susceptible: less than or equal to 1mg/L.
Resistant: greater than 256 mg/L.
Studies have shown that following topical application of mupirocin there is very little systemic absorption of drug-related material. To mimic possible enhanced systemic penetration of mupirocin by application to damaged skin or a vascular site such as the mucous membrane, intravenous studies have been performed. Mupirocin was rapidly eliminated from the plasma by metabolism to monic acid, which in turn was excreted mainly in the urine.
Pre-clinical effects were seen only at exposures which are extremely unlikely to cause concern for humans under normal conditions of clinical use. Mutagenicity studies revealed no risks to man.
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