Mupirocin

Mupirocin (bactroban) is active against many gram-positive and selected gram-negative bacteria. It has good activity against S. pyogenes and methicillin-susceptible and methicillin-resistant strains of S. aureus. It is bactericidal at concentrations achieved with topical application.

Mupirocin inhibits bacterial protein synthesis by reversible inhibition of Ile tRNA synthase. There is no cross-resistance with other antibiotic classes. clinically insignificant, low-level resistance results from mutations of the gene encoding Ile tRNA synthase or an extra chromosomal copy of a gene encoding a modified Ile tRNA synthase. High-level resistance is mediated by a plasmid or chromosomal copy of a gene encoding a "bypass" synthetase that binds mupirocin poorly.

Mupirocin is available as a 2% cream or ointment for dermatologic use and as a 2% ointment for intranasal use. The dermatological preparations are indicated for treatment of traumatic skin lesions and impetigo secondarily infected with S. aureus or S. pyogenes. Systemic absorption through intact skin or skin lesions is minimal. Any mupirocin absorbed is rapidly metabolized to inactive monic acid.

Mupirocin is effective in eradicating S. aureus carriage. The consensus is that patients who may benefit from mupirocin prophylaxis are those with proven S. aureus nasal colonization plus risk factors for distant infection or a history of skin or soft tissue infections.

Mupirocin may cause irritation and sensitization and contact with the eyes should be avoided. Systemic reactions to mupirocin occur rarely, if at all. Application of the ointment to large surface areas should be avoided in patients with renal failure to avoid accumulation of polyethylene glycol from the ointment.

For a complete Bibliographical listing see Goodman & Gilman's The Pharmacological Basis of Therapeutics, 11th ed., or Goodman & Gilman Online at www.accessmedicine.com.

CHEMOTHERAPY OF TUBERCULOSIS, MYCOBACTERIUM AVIUM COMPLEX DISEASE, AND LEPROSY

Mycobacteria cause tuberculosis, Mycobacterium avium complex (MAC) disease, and leprosy. Tuberculosis remains the leading worldwide cause of death due to infectious disease. "First-line" agents for the chemotherapy of tuberculosis combine the greatest efficacy with an acceptable degree of toxicity (Table 47-1), and the large majority of patients with tuberculosis are treated successfully with these drugs. Occasionally, it may be necessary to resort to "second-line" drugs.

Diabetes 2

Diabetes 2

Diabetes is a disease that affects the way your body uses food. Normally, your body converts sugars, starches and other foods into a form of sugar called glucose. Your body uses glucose for fuel. The cells receive the glucose through the bloodstream. They then use insulin a hormone made by the pancreas to absorb the glucose, convert it into energy, and either use it or store it for later use. Learn more...

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