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Boils, carbuncles, folliculitis, paronychia and staphylococcal whitlow - Evidence
Evidence on staphylococcal carriage
A UK randomized controlled trial (RCT) found that mupirocin ointment was more effective than chlorhexidine/neomycin cream at both eradicating Staphylococcus aureus from nasal carrier sites and preventing recolonization [Leigh and Joy, 1993].
- Participants:
- A total of 99 people participated, of whom 32 were index cases with active infection when first seen, and 67 were family contacts.
- Families with recurrent superficial staphylococcal skin infections (e.g. furunculosis and styes) were referred to a hospital outpatient department. In people with infected lesions, the lesions and potential carrier sites were swabbed.
- All other members of the family were screened by swabbing the same sites (anterior nares, axillae, groin, and perianal regions).
- Full treatment was given to all members of the family, whether or not they were staphylococcal carriers.
- A total of 66 out of 99 people (67%) were nasal carriers of S aureus.
- Treatments:
- Mupirocin (2%) nasal ointment and chlorhexidine 0.1%/neomycin 0.5% (Naseptin®) cream were compared. The nasal preparation was applied to the anterior nostrils, morning and evening, for 7 days.
- If treatment with chlorhexidine/neomycin failed, mupirocin was then used. These patients were not randomized and were therefore treated as a separate group.
- The authors mentioned that patients do not find it easy to follow the treatment procedure accurately, and that detailed instructions are needed.
- A nurse interviewed all the families before and after treatment and collected follow-up swabs (and swabs of any infected lesions present) at 8, 14, 28, and 91 days after starting treatment.
- Results:
- Treatment was assessed by the eradication of S. aureus from carrier sites, and the prevention of recurring infective lesions.
- Eradication of S. aureus from positive nasal carrier sites at 8 days was 95% with mupirocin, 61% with chlorhexidine/neomycin, and 85% in the group treated with mupirocin after unsuccessful chlorhexidine/neomycin treatment.
- Recolonization occurred sooner with chlorhexidine/neomycin cream than with mupirocin, with 89% and 43% respectively becoming recolonized at 91 day follow-up.
- Confidence intervals and p-values were not stated.
- Harms:
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