Retapamulin

As proposed earlier, we found that mild/moderate NV responded to intranasal antibiotics (90 %, mupirocin-based), while severe cases required oral antibiotics. Many patients had no dermatology follow-up (34 %); however, NV cleared in 60 % of episodes without complications/hospitalization, perhaps due to timely treatment. For mild cases, saline humidification, nasal emollients, and use of antibiotic ointments (e.g., mupirocin, retapamulin, bacitracin zinc/polymyxin B, chlorhexidine/neomycin) are advised. With the use of emollients (e.g., petroleum jelly, mineral oils) inappropriate for intranasal use, the rare development of lipoid pneumoniamust be considered. For severe infections, it is appropriate to administer oral antibiotics based on susceptibility patterns. For recurrences, consider decolonization; however, this approach has limited success; indiscriminate use of intranasal mupirocin may lead to development of resistance. Resistance rates range from 3 to 5 % among MRSA isolates in US/Canadian hospitals; and 1.7 % for MSSA in Latin America. Lastly, in chronic/persistent NV, cutaneous neoplasms (e.g., basal or squamous cell carcinoma) should be ruled out.

A new agent, retapamulin, was recently FDA approved for the topical treatment of impetigo due to susceptible strains of S. aureus and GAS. Retapamulin is a pleuromutilin, a new antibiotic class that inhibits protein synthesis, and resistance to retapamulin may be less likely to develop due to its unique mechanism of action. In vitro studies have found that retapamulin has activity against MSSA, MRSA, and GAS.