The elimination of nasal carriage of staphylococci, including methicillin resistant Staphylococcus aureus (MRSA).

Dosage: Adults (including the elderly) and children:
Avoban Nasal Ointment should be applied to the anterior nares two to three times a day as follows:
A small amount of the ointment about the size of a match head is placed on the little finger and applied to the inside of each nostril. The nostrils are closed by pressing the sides of the nose together; this will spread the ointment throughout the nares. A cotton bud may be used instead of the little finger for the application in particular to infants or patients who are very ill.
Nasal carriage should normally clear within 5-7 days of commencing treatment.

Should a possible sensitisation reaction or severe local irritation occur with the use of Avoban
Nasal Ointment, treatment should be discontinued, the product should be wiped away and
appropriate therapy instituted.
As with other antibacterial products, prolonged use may result in overgrowth of non-susceptible
organisms.
Avoid contact with the eyes. If contaminated, the eyes should be thoroughly irrigated with water
until the ointment residues have been removed.

The product is not known to interact with other medicaments.

Pregnancy Category B:
Pregnancy: Reproduction studies in animals have revealed no evidence of harm to the foetus.
As there is no clinical experience on its use during pregnancy, It should only be used in pregnancy when the potential benefits outweigh the possible risks of treatment.
Lactation: There is no information on the excretion in milk.

None known.

Adverse reactions are listed below by system organ class and frequency. Frequencies are defined
as: very common (≥1/10), common (≥1/100, <1/10), uncommon (≥1/1000, <1/100), rare
(≥1/10,000, <1/1000), very rare (<1/10,000).
Immune system disorders:
Very rare: Cutaneous hypersensitivity reactions.
Respiratory, thoracic and mediastinal disorders
Uncommon: Nasal mucosa reactions.

The toxicity of mupirocin is very low. In the event of overdose, symptomatic treatment should be given.

Pharmacotherapeutic group: Dermatologicals
Antibiotics and chemotherapeutics for dermatological use.

Mode of Action
Mupirocin is a novel antibiotic produced through fermentation by Pseudomonas fluorescens.
Mupirocin inhibits isoleucyl transfer-RNA synthetase, thereby arresting bacterial protein
synthesis.
Mupirocin has bacteriostatic properties at minimum inhibitory concentrations and bactericidal
properties at the higher concentrations reached when applied locally.
Mechanism of Resistance
Low-level resistance in staphylococci is thought to result from point mutations within the usual
staphylococcal chromosomal gene (ileS) for the target isoleucyl tRNA synthetase enzyme. Highlevel
resistance in staphylococci has been shown to be due to a distinct, plasmid encoded
isoleucyl tRNA synthetase enzyme.
Intrinsic resistance in Gram negative organisms such as the Enterobacteriaceae could be due to
poor penetration of the outer membrane of the Gram-negative bacterial cell wall.
Due to its particular mode of action, and its unique chemical structure, mupirocin does not show
any cross-resistance with other clinically available antibiotics.
Microbiological Susceptibility
The prevalence of acquired resistance may vary geographically and with time for selected
species, and local information on resistance is desirable, particularly when treating severe
infections. As necessary, expert advice should be sought when the local prevalence of resistance
is such that the utility of the agent in at least some types of infection is questionable.

Commonly susceptible species
Staphylococcus aureus*
Streptococcus pyogenes*
Streptococcus spp. (β-haemolytic, other than S. pyogenes)
Species for which acquired resistance may be a problem
Staphylococcus spp., coagulase negative
Inherently resistant organisms
Corynebacterium spp.
Micrococcus spp.

Studies have shown that following topical application of mupirocin there is very little systemic absorption of drug-related material. To mimic possible enhanced systemic penetration of mupirocin by application to damaged skin or a vascular site such as the mucous membrane, intravenous studies have been performed. Mupirocin was rapidly eliminated from the plasma by metabolism to monic acid, which in turn was excreted mainly in the urine.

None Known

White soft paraffin
Glycerol fatty acid ester

none.

Store below 30°C.

Aluminum tube with plastic screw cap

Any unused product or waste material should be disposed of in accordance with local requirements.