Comparison of Efficacy of Intranasal with Oral Anti-Staphylococcal Treatments in Control of Infection among Hospital MRSA Carriers

Hospital nasal carriage, among health care staff, of methicillin resistant S. aureus (HNC-MRAS) have an important role in hospital-acquired infections (HAI) in admitted patients, which can lead to various complications such as wound infection, catheter related bacterimia, neonatal sepsis, with high mortality rates and socio-economic and health impacts. The aim of the present case-control clinical trial was to compare the efficacy of various anti-microbial treatments in the control of MRSA. Seventy six HC-MRSA of the heath care staff who were positively identified as HC-MRSA in Razi hospital, an educational hospital of AJUMS, were randomly allocated into 5 groups. The first group was used as placebo-treated control. The remaining groups were treated for seven days twice daily with intra-nasal application of 2% mupirocin ointment, 2% vancomycin jell, or orally 500 mg cloxacillin QID plus daily 600 mg rifampicin or 2Tablet adult co-trimoxazol twice daily plus daily 600 mg rifampicin. The results showed that there was significant reduction in the MRSA following intranasal mupirocin ointment and voncomycin jell which eliminated 93% and 86% of nasal carriage respectively. Oral treatment (cloxacillin 500mg Q6h plus rifampicin 600 mg daily) or (co-trimoxazol 2 adult tablets Q12h plus 600 mg rifampicin daily) resulted in 100% elimination of nasal carriers in HNC- MRSA. These results suggest that HNC-MRSA can be controlled with intranasal mupirocin or vancomycin. In cases that do not respond to topical treatment or due to drug hypersensitivity, cloxacillin plus rifampicin or co-trimoxazol plus rifampicin are recommended.