Guidelines for Eradication of MRSA Carriage

Simor, A.E., Phillips, E., McGeer, A., Konvalinka, A., Loeb, M., Devlin, H.R., & Kiss, A. (2007). Randomized control trial of chlorhexidine gluconate for washing, intranasal mupirocin, and rifampin and doxycycline versus no treatment for the eradication of methicillin-resistant Staphylococcus aureus colonization. Clin Infect Dis, 44: 178-185.

In a randomized trial of 146 hospitalized patients colonized with MRSA, participants were assigned to receive either no treatment or a 7 day treatment with rifampin (300mg bid), doxycycline (100 mg bid), daily chlorhexidine washes, and nasal mupirocin (tid). At three months post-treatment, seventy-four percent of the treatment group were decolonized compared to thirty-two percent of the control group. While these findings support the efficacy of MRSA eradication measures, it is unclear whether routine use of these measures is beneficial due to the potential development of resistant and more virulent strains and the likelihood that patients and healthcare providers in inpatient settings will be recolonized. However, decolonization strategies may serve some utility during hospital-based or household-based MRSA outbreaks and among individuals with recurrent MRSA infections.


[UpToDate] Author: Harris, A. & Boyce, J.M. "Prevention and control of methicillin-resistant Staphylococcus aureus in adults" Last updated May 28, 2009.

Decolonization measures generally include both systemic and topical antimicrobial therapy.
Systemic Therapy:

• A 7-14 day antibiotic regimen may be implemented based on antibiogram findings. Studies have found systemic therapy effective in eliminating MRSA carriage. However, as mentioned previously, systemic antibiotics should be used prudently due to the potential for immerging resistance.

Topical Therapy:

• Mupirocin inhibits bacterial protein and RNA synthesis. Intranasal mupirocin ointmnet is applied to the anterior nares 2-3 times daily for 5-7 days. Findings from studies of intranasal mupirocin monotherapy are mixed.
• Chlorhexidine binds to the bacterial cell wall and alters osmotic equilibrium leading to bacterial cell death. Body washing with chlorhexidine is recommended 1-2 times daily for 5-7 days. Chlorhexidine body washing has only been found to reduce or eliminate MRSA carriage when patients were concurrently applying mupirocin intranasal ointment. Please see my blog posting from 10/25/09 for a description of a RCT on chlorhexidine body washes for MRSA eradication.