Korean J Intern Med.  2015 Jul;30(4):515-520. 10.3904/kjim.2015.30.4.515.

Drug utilization review of mupirocin ointment in a Korean university-affiliated hospital

• Youn SH
• Lee SS
• Kim S
• Lee JA
• Kim BJ
• Kim J
• Han HK
• Kim JS

• KMID: 2366012
• DOI: http://doi.org/10.3904/kjim.2015.30.4.515

Abstract

BACKGROUND/AIMS
Intranasal mupirocin and chlorhexidine bathing are candidate strategies to prevent healthcare-associated infections caused by methicillin-resistant Staphylococcus aureus (MRSA). In Korea, intranasal mupirocin is not available, and mupirocin ointment, an over-the-counter drug, has been used indiscriminately. Furthermore, because it is covered by health insurance, mupirocin is easy to prescribe within hospitals.
METHODS
We performed a mupirocin drug utilization review (DUR) within Hallym University Sacred Heart Hospital. Annual use of mupirocin was investigated between 2003 and 2013, and monthly consumption of mupirocin was assessed during the final 2-year period. The DUR focused on August 2012, the period of highest use of mupirocin. Also, we investigated trends in mupirocin resistance in MRSA between 2011 and 2013.
RESULTS
Annual consumption of mupirocin increased from 3,529 tubes in 2003 to 6,475 tubes in 2013. During August 2012, 817 tubes were prescribed to 598 patients; of these, 84.9% were prescribed to outpatients, and 77.6% at the dermatology department. The most common indication was prevention of skin infections (84.9%), and the ointment was combined with systemic antibiotics in 62.9% of cases. The average duration of systemic antibiotic administration was about 7.8 days. The rate of low-level mupirocin resistance in MRSA increased from 8.0% to 22.0%, and that of high-level mupirocin resistance increased from about 4.0% to about 7.5%.
CONCLUSIONS
Inappropriate use of mupirocin is prevalent. Considering the increase in resistance and the future application of intranasal mupirocin, prophylactic use of mupirocin in dermatology departments should be reconsidered.

Keyword

Drug utilization review; Mupirocin; Drug resistance, bacterial; Methicillin-resistant Staphylococcus aureus

MeSH Terms

Administration, Cutaneous
Anti-Bacterial Agents/*administration & dosage/adverse effects
Drug Prescriptions
Drug Resistance, Multiple, Bacterial
Drug Utilization Review
*Hospitals, University
Humans
Inappropriate Prescribing/*trends
Methicillin-Resistant Staphylococcus aureus/*drug effects
Microbial Sensitivity Tests
Mupirocin/*administration & dosage/adverse effects
Ointments
Practice Patterns, Physicians'/*trends
Predictive Value of Tests
Republic of Korea
Retrospective Studies
Staphylococcal Skin Infections/diagnosis/*drug therapy/microbiology
Time Factors
Anti-Bacterial Agents
Ointments
Mupirocin