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Year : 1990  |  Volume : 56  |  Issue : 3  |  Page : 204-207

An open comparlson of mupirocln and oxyteracycline for the therapy of skin infections

Vinay Kulkarni, MB Gharpuray, SS Nene 
 

Correspondence Address:
Vinay Kulkarni


Abstract

Mupirocin (pseudomonic acid) is a new antibacterial compound active against a wide range of organisms responsible for skin and soft tissue infections. It is bactericidal at concentrations achieved following topical application. An open comparative study was carried out to assess the clinical and bacteriological effectiveness of 2% muhirocin as compared to 3% oxytertracycline by topical application in a variety of primary and secondary skin infections. Fifty patients were included in each age and sex matched group. The overall efficacy of mupirocin was 92% compared to 80% of oxytetracycline. Mupirocin was especially effective in cases of impetigo, 75% cases being cured and 25% showing good improvement at the end of 12 days. With oxytetracycline the figures were 40% cured and 33.3% showing good response. The speed of recovery with mupirocin was faster than with oxytetracycline.



How to cite this article:
Kulkarni V, Gharpuray M B, Nene S S. An open comparlson of mupirocln and oxyteracycline for the therapy of skin infections.Indian J Dermatol Venereol Leprol 1990;56:204-207


How to cite this URL:
Kulkarni V, Gharpuray M B, Nene S S. An open comparlson of mupirocln and oxyteracycline for the therapy of skin infections. Indian J Dermatol Venereol Leprol [serial online] 1990 [cited 2020 Jul 6 ];56:204-207
Available from: http://www.ijdvl.com/text.asp?1990/56/3/204/3525


Full Text

It is now 20 years since the last product was introduced for the treatment of skin infections and therefore the development of this new and unique antibiotic, mupirocin, has been very worthwhile[1]. Pseudomonic acid is derived from the submerged fermentation of Pseudomonas fleurescences. Though the name may suggest, this drug has no activity against Pseudomonas. To avoid confusion the generic name has been changed to mupirocin. It has a novel structure and thus it is not readily classifiable with any of the known groups of antibiotics[2]. At low concentrations, close to the minimum inhibitory concentration, the sodium salt of mupirocin is bacteriostatic in its action against Staphylococcus aureus and Escherichia coil[3]. At higher concentrations, the antibiotic becomes progressively bactericidal. It acts through the arrest of protein synthesis by a powerful competitive inhibition of the formation of the enzyme (isoleucyl transfer - RNA - synthetase) - isoleucyladenylate complex[4].

The compound mupirocin has been developed as a topical antibiotic for the treatment of various skin infections and is formulated as 2% mupirocin in polyethylene glycol ointment base. Mupirocin is highly effective against gram positive bacteria but is less effective against Gram negative bacteria[5]. During an outbreak of methicillin resistant staphylococci, Dacre et al[6] were impressed with the eradication of nasal carriage by mupirocin.

Evaluation of mupirocin with regard to its potential as a contact sensitizer by repeated applications to an area of low grade dermatitis induced with sodium lauryl sulphate (maximization procedure) revealed that mupirocin possessed an extremely low sensitization potential. Phototoxic and photoallergic potentials, assessed in human volunteers exposed to ultraviolet light and mupirocin ointment revealed no phototoxic or photo - allergic reactions[7].

We undertook an open comparative study of 2% mupirocin and 3% oxytetracycline ointment for the treatment of skin infections.

 Materials and Methods



A single-center, comparative, open trial of mupirocin and oxytetracycline was done on adult or children patients of either sex having a skin infection at any site amenable to treatment with a topical antibiotic. Patients who had taken a topical or systemic antibiotic concurrently or within the preceding 48 hours, those receiving corticosteroids, patients with severe infections requiring systemic therapy, and pregnant or suspected pregnant women were excluded. Each patient was given a suitable volume of either of the ointment or cream to be applied to the affected area twice a day for 5 days. The treatment was continued for another 5 days if required. The last evaluation was done on the 12th day. If the condition worsened, the case was taken as a failure and suitable treatment was given. Bacteriological culture was done before starting the therapy.

 Results



A total of 100 patients were enrolled, 50 each receiving mupirocin or oxytetracycline. There were 34 males and 16 females in the mupirocin group and 29 males and 21 females in the oxytetracycline group. The age range in the mupirocin group was 1 to 43 years and in the oxytetracycline group it was 1 to 60 years. Maximum number of patients in both the groups were children below the age of 10 years.

In the mupirocin group, there were 42 moderate and 8 severe infections and in the oxytetracycline group, 44 cases were moderate and 6 were severe. The response of these cases according to the clinical diagnosis is shown in [Table 1].

The organisms isolated from the cases and their response to these two drugs are shown in [Table 2]. Antibiotic susceptibility studies revealed that staphylococci and streptococci were always susceptible to mupirocin including the penicillin resistant strains. Many of these were resistant to tetracycline. The E. Coli, Klebsiella and Proteus species were also susceptible to mupirocin but Pseudomonas and Candida were resistant. The overall efficacy of mupirocin was 92% as compared to oxytetracycline. Mupirocin was especially effective in cases of impetigo.

There were no side effects noted with either drug during the study.

 Comments



The overall efficacy of mupirocin was 92% while that of oxytetracycline was 80%. The speed of recovery with mupirocin was definitely superior to that with oxytetracycline. Mupirocin was especially effective in cases of impetigo, the overall efficacy being 100% as compared to 73% with oxytetracycline. Wainscott and Huskssone[8] reported similar results in a comparative study of mupirocin and chlortetracycline. In another study, 14 of 17 children with impetigo were cured with mupirocin in 8 days, compared to 8 out of 19 with the vehicle alone9. It has been suggested that mupirocin is as effective as oral antibiotics such as erythromycin or dicloxacillin but well controlled, double blind trials have not been done[10].

 Acknowledgements



Dr V N Mehta, German Remedies, provided the drugs and technical co-operation.

References

1Price JD : Introduction, in : Bactroban (Mupirocin), Current Clinical Practice Series 16, Editors, Dobson RL, Leyden JJ, Noble WC et al : Excerpta Medica, Amsterdam, 1985, p 1-2.
2Mellows G : Pseudomonic acid : its chemistry and metabolism, in : Bactroban (Mupirocin), Current Clinical Practice Series 16, Edidors, Dobson RL, Leyden JJ, Noble WC et al : Excerpta Medica, Amsterdam, 1985; 3-10.
3Hughes J and Mellows G : On the mode of action of pseudomonic acid : Inhibition of protein synthesis in Staphylococcus aureus, J Antibiot, 1978; 31:330335 (Quoted by 2).
4Hughes J and Mellows G : Interaction of pseudomonic acid A with Escherichia coli B Isoleucll-tRNA synthetase, Biochem J, 1980; 191:209-219 (Quoted by 2).
5White AR, Beale AS, Boon RJ et al : Antibacterial activity of mupirocin, in : Bactroban (Mupirocin), Current Clinical Practice Series 16, Editors, Dobson RL, Leyden JJ, Noble WC et al : Excerpta Medica, Amsterdam, 1985; p 19-36.
6Dacre JE, Emmerson AM and Jenner EA . Nasal carriage of gentamicin and moth 1 c! 11 in -resistant Staphylococcus aureus treated with topical pseudomonic acid, Lancet, 1983; 11:1036.
7Leyden JJ : Studies on the safety of Bactroban ointment : potential for contact allergy; contact irritation, photo-toxicity and photo-allergy, in : Bactroban (Mupirocin), Current Clinical Practice Series 16, Editors, Dobson RL, Leyden JJ, Noble WC et al: Excerpta Medica, Amsterdam, 1985; p 68-71.
8Wainscott G and Huskisson SC : A comparative study of Bactroban ointment and chlortetracycline cream, in : Bactroban (Mupirocin), Current Clinical Practice Series 16, Editors, Dobson RL, Leyden JJ, Noble WC et al : Excerpta Medica, Amsterdam, 1985; p 137-140.
9Eells LD, Mertz PM, Piovanetti Y et al : Topical antibiotic treatment of impetigo with mupirocin, Arch Dermatol, 1986; 122:1273-1276.
10Gratton D : Topical mupirocin versus oral erythromycin in the treatment of primary and secondary skin infections, Internat J Dermatol, 1987; 26:472-473.

 

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