Shortages?! Slowly, I get used to it.  Basic antibiotics such as penicillins, CHX-wipes, or now, mupirocin. From what I hear we have to expect severe shortages (= no product) for the next few months. As the use of mupirocin for nasal decolonization of S. aureus (in combination with CHX skin wash) has become part of the pre-operative care for certain indications, the obvious question is: WHAT SHOULD I USE INSTEAD?

To be honest, I have no clue.  A proven, equally effective product, that – as mupirocin – has no real side-effects, is not know to me and probably not on the market. (Prove me wrong and I will actually be very grateful). Some alternatives are far less active and/or not intended for nasal application such as Teatree-oil, bacitracin, and fucidic-acid. One intended alternative, Prontoderm nasal gel, was shown to be inferior to mupirocin by Harbarth et al. Newer products such as retapamulin, lysostaphin, P128 hydrogel en ClyS (using phages) never made/never will make it to the market. A povidone-iodine nasal antiseptic, that my nares tried out during a recent visit in Asia, might be a good alternative, but is not available in Western Europe.

Thus, what to do?  Number one, stop treating every patient (which many do) and return to targeted treatment of proven carriers. True, this means a far more complicated logistics, including pre-operative screening, but might even help to prevent mupirocin resistance (for in the future when there is mupirocin that can be used).

I will use one of the first four products mentioned above in combination with (in our case) CHX-wipes, hopefully in a kind of a research setting.  Despite the fact that I’m usually not shy with my opinions or decisions, I would have no clue which product to advise. Thus, any comment, especially from people without a conflict of interest, is very welcome!