Regular mupirocin and the nasal version contain the same antibiotic at the same strength, so the medicine itself isn’t the difference. What differs is the ointment that carries it, and that is why the skin tube isn’t meant for the inside of your nose.1DailyMed. BACTROBAN NASAL- mupirocin calcium ointment2US Pharmacist. Mupirocin 1% in Normal Saline Nasal Suspension If you’re asking because a surgeon wants staph cleared from your nose before an operation, there is a separate nasal product with its own instructions, and it’s worth asking for it rather than improvising.
How the Skin Ointment and the Nasal Ointment Differ
Each gram of regular Bactroban 2% ointment holds 20 mg of mupirocin in a base of polyethylene glycol 400 and 3350, a water-mixing ointment made for skin.3US Pharmacist. Mupirocin 1% in Normal Saline Nasal Suspension Bactroban Nasal, by contrast, contains mupirocin calcium equal to 2% mupirocin in a soft white base of paraffin and glycerin esters.4DailyMed. BACTROBAN NASAL- mupirocin calcium ointment Pharmacists note that the nasal ointment won’t even mix with salt water the way the skin ointment can.5US Pharmacist. Mupirocin 1% in Normal Saline Nasal Suspension The nasal ointment has also had its own FDA approval since 1995, with directions written for the nostrils.6FDA. BACTROBAN (mupirocin calcium) nasal ointment Nasal lining is thin and moist, unlike the tougher skin the regular base was designed for, so the same drug in a different base is effectively a different product for your nose.
To tell which tube you have, look at the box. The nasal product says “nasal” and comes in small single-use tubes. Regular mupirocin ointment comes in a larger multi-use tube labeled for skin, and a cream version also exists that is likewise for skin only. If the label doesn’t say nasal, assume it’s the skin product.
If you’ve already put the skin ointment in your nose once or twice, that is not an emergency. If it stung or your nose got runny, stop and switch to the nasal product. If a surgeon told you to clear staph before an operation, tell the surgical team what you used and for how many days. They may want you to redo the course with the nasal product, because a course done with the skin tube shouldn’t be assumed to count; it wasn’t designed or tested for that purpose.
At the pharmacy, ask for “mupirocin nasal ointment” by name, since asking only for mupirocin may get you the skin tube. If your prescription just says “mupirocin 2% ointment,” ask the prescriber or pharmacist to confirm which one was meant. Nasal mupirocin is a prescription product in the US, so a pharmacist can check what your surgeon intended and help you find it. If it’s out of stock, ask the pharmacist to call the prescriber rather than handing you the skin tube as a swap.
Why the Skin Version Can Bother the Inside of Your Nose
Your nose cleans itself with tiny beating hairs that sweep mucus toward the throat. In lab tests on nasal cells, several common ointment and solvent ingredients, including polyethylene glycols, slowed that beating.7PubMed. Solubilizing agents in nasal formulations and their effect on ciliary beat frequency Some of the slowing reversed once the ingredient was removed, but not all of it.8PubMed. Solubilizing agents in nasal formulations and their effect on ciliary beat frequency In rabbits, PEG-based nasal products caused only mild tissue changes over two weeks of daily use.9PubMed. Single- and repeated-dose local toxicity in the nasal cavity of rabbits after intranasal administration of different glycols for formulations containing benzodiazepines So a dab of skin ointment used briefly is unlikely to cause serious harm, but it isn’t tested or labeled for repeated use in the nose.
If the base does bother you, it would most likely feel like stinging or burning just inside the nostril after you apply it, or a runny or stuffy nose that wasn’t there before. These findings come from lab cells and animals, not from studies of people using skin tubes in their nose, so they are a reason the base wasn’t chosen for the nose rather than proof the skin tube damages it.
Where the sore is also matters. The skin ointment is designed for skin, including the outer edge of the nostril. Packing it deep inside is a different situation from treating a crack at the opening, and a pharmacist can help you sort out which one you have.
If you’ve been using it for a crusty nostril, know that crusting inside the nose has many causes, including dry air, picking, allergies and nasal sprays, so an antibiotic isn’t always the fix. If a sore keeps coming back or lasts more than a couple of weeks, have a clinician look at it instead of repeating the tube. The same goes for a sore that bleeds easily, grows, or doesn’t heal. Depending on what they see, a clinician may suggest the nasal product, a saline rinse, or a gentle moisturizer.
Don’t Swap In Petroleum Jelly or Vapor Rub Either
Breathing in fatty or oily substances can inflame the lungs.10PubMed. Pharmacists can help prevent lipoid pneumonia: Two case reports Petroleum jelly melts at body temperature, so it can trickle back and be breathed in without triggering a cough.11PubMed Central. Nasal application of petrolatum ointment – A silent cause of exogenous lipoid pneumonia: Successfully treated with prednisolone Mineral oil, petroleum jelly, vapor rub and even lip gloss have all been linked to it.12PubMed. Pharmacists can help prevent lipoid pneumonia: Two case reports Adult cases from long-term nasal use are rare, though probably missed, and range from no symptoms to serious breathing trouble.13American Journal of Respiratory and Critical Care Medicine. A42-04 From Decongestion to Desaturation: Exogenous Lipoid Pneumonia From Intranasal Petroleum-Based Ointment Use
The concern is oily material slowly reaching the airways, where the lungs can’t easily clear it. The amount is tiny each time, so trouble tends to build over months or years of daily use, not after a few days. A short course of a prescribed nasal ointment is a different situation from using an oily balm every day for years. Water-based saline sprays and gels don’t carry this oil-related risk in the same way, which is why they’re often suggested for dryness.
If you do use a nasal ointment regularly, a lingering cough or shortness of breath without a cold is worth mentioning to your doctor. Say that you use the ointment, since it’s easily overlooked. Using small amounts in the front of the nostril, rather than packing it deep, keeps less of it where it can travel.
For a dry, sore nose, a saline spray or saline gel is a common first step because it adds moisture without a heavy oil layer. A humidifier in a dry bedroom can help the lining stay moist overnight. For cracked skin at the nostril rim, use a thin smear on the outer edge only. If dryness or crusting persists, a clinician can look for causes rather than you stacking products.
Does Mupirocin in the Nose Actually Work Before Surgery
Mupirocin stops staph bacteria from making the proteins they need to live.14PubMed. A review on mechanism of action, resistance, synergism, and clinical implications of mupirocin against Staphylococcus aureus Many people carry staph harmlessly in the nose, including MRSA, a resistant type, and the aim before surgery is to clear it. Compared with no treatment, mupirocin cut nasal staph carriage by roughly 78% and staph wound infections by about a third.15PubMed. Mupirocin-based nasal decolonization to prevent Staphylococcus aureus surgical site infections: A meta-analysis of randomized control trials Among people who carried staph, hospital staph infections fell from 7.7% to 4.0% with mupirocin.16PubMed. Intranasal mupirocin to prevent postoperative Staphylococcus aureus infections The strongest evidence is for orthopedic surgery, with benefit also for heart surgery.17PubMed. Nasal decolonization: What antimicrobials and antiseptics are most effective before surgery and in the ICU
That’s why your surgeon may swab your nose first. The swab shows whether you carry staph, and the benefit is clearest for carriers. Some hospitals skip testing and treat everyone, so follow your hospital’s specific instructions.
Carrying staph says nothing about hygiene, and most carriers never get sick from it. Surgery is one of the times the bacteria get a chance to cause trouble.
The goal is to lower the number of staph bacteria that can travel from your nose to your own skin and into a surgical wound. It’s one layer of prevention alongside antibiotics given around surgery and skin cleansing, not a stand-alone guarantee, and some people still get infections after a good course. Staph can also return to the nose over time, so timing close to surgery matters.
How to Apply Nasal Mupirocin
- Prepare: Blow your nose first if you can, which makes the ointment feel less thick.18Agency for Healthcare Research and Quality. Decolonization of Non-ICU Patients With Devices
- Apply: Put about half the single-use tube in one nostril and half in the other.19U.S. Food and Drug Administration. BACTROBAN (mupirocin) nasal ointment
- Spread: Press the sides of the nose together and release repeatedly for about 1 minute to spread it.20U.S. Food and Drug Administration. BACTROBAN (mupirocin) nasal ointment
- Repeat: Do this morning and evening for 5 days.21U.S. Food and Drug Administration. BACTROBAN (mupirocin) nasal ointment
- Surgery day: The WHO surgical guideline adds one dose on the morning of surgery.22World Health Organization. Global guidelines for the prevention of surgical site infections
To fit this around surgery, count back 5 days from your surgery date to find your start. Missing doses may leave staph behind. Ask whether your hospital wants a surgery-day dose. Don’t share tubes; they are single use.
Wash your hands before and after, since the aim is to move staph out of your nose, not onto your fingers. Use a clean fingertip or cotton swab to place the ointment just inside the nostril, not deep up the nose, and avoid blowing your nose right after. Throw the tube away after the dose, because a tube opened and reused can carry bacteria back into your nose.
The most common complaint is the thick, goopy feel.23Agency for Healthcare Research and Quality. Decolonization of Non-ICU Patients With Devices Gentle massage helps it spread, and the feeling doesn’t mean you used too much.
If you miss a dose, apply it when you remember unless the next dose is close, and don’t double up. If you miss more than a dose or two, tell your surgical team so they can decide whether to extend the course. Don’t stretch the course past what you were told to make up for missed doses without checking first.
Side Effects to Expect
In US trials, about 6% of adults got a runny nose and 2% burning or stinging.24Food and Drug Administration. BACTROBAN Nasal Ointment Headache, sore throat, taste changes, cough and itching were also reported.25U.S. Food and Drug Administration. BACTROBAN (mupirocin) nasal ointment Whole-body effects are uncommon because very little is absorbed into the body, with under 1% of a skin dose showing up in urine.26Journal of Dermatological Treatment. Systemic absorption of mupirocin after topical application of mupirocin ointment to healthy and dermatologically diseased skin In hospitalized newborns it was well tolerated, though mild rashes were more common.27PubMed Central. Mupirocin for Staphylococcus aureus Decolonization of Infants in Neonatal Intensive Care Units
A bit of stinging right after the ointment goes in, or a runny nose for a few minutes, is expected and tends to ease. Symptoms that keep getting worse across the 5 days point to a problem rather than an adjustment period. A new rash or swelling that appears after you started is different from the nose simply feeling goopy.
Low absorption is also why the ointment is usually considered fine alongside most other medicines, though you should still give your pharmacist your medication list. It doesn’t rule out a local allergic reaction at the site, which can still happen. Call your doctor for severe or worsening burning, swelling or a rash spreading on the face, or any sign of allergy such as hives.
Resistance and Why Not to Overuse It
Some staph resist mupirocin strongly through an acquired gene, and others resist it weakly through a mutation.28PubMed. Mupirocin resistance In one South African hospital, 2% of staph strongly resisted it and 9% weakly.29PubMed Central. The prevalence and molecular mechanisms of mupirocin resistance in Staphylococcus aureus isolates from a Hospital in Cape Town, South Africa Using leftover mupirocin casually in your nose can help resistant staph spread, so save it for when a doctor directs nasal use. Each time mupirocin reaches a nose, it removes sensitive staph and leaves the resistant ones to multiply, and resistance can spread between people, including family members and hospital patients.
For you, resistance can mean treatment may not clear your nose, and your hospital may switch to iodine. Mention any past mupirocin courses. Ask your pharmacist how to dispose of leftover ointment instead of keeping it for later.
Alternatives If You Can’t Use Mupirocin
Among about 1,900 surgery patients, 3.4% found iodine unpleasant versus 38.8% with mupirocin ointment.30PubMed. Patient experience with mupirocin or povidone-iodine nasal decolonization Iodine worked on MRSA in lab tests regardless of mupirocin resistance.31PubMed Central. Efficacy of Skin and Nasal Povidone-Iodine Preparation against Mupirocin-Resistant Methicillin-Resistant Staphylococcus aureus and S. aureus within the Anterior Nares In ICU patients, though, mupirocin beat iodine at preventing staph infections.32JAMA. Nasal Iodophor Antiseptic vs Nasal Mupirocin Antibiotic in the Setting of Chlorhexidine Bathing to Prevent Infections in Adult ICUs: A Randomized Clinical Trial Alcohol-based nasal antiseptics are another option, with limited evidence so far.33Open Forum Infectious Diseases. 567. Does Universal Nasal Decolonization with an Alcohol-Based Nasal Antiseptic Reduce Infection Risk and Cost?
The iodine swab is applied to the inside of the nostrils, often by staff shortly before surgery. That one-time timing differs from the 5-day home course used for mupirocin, and because the hospital applies it, you may not need to do anything at home. The best choice depends on your hospital’s protocol, your resistance risk and your allergies.
Ask your surgical team which agent your hospital uses, and mention any iodine allergy. People with certain thyroid conditions should mention them, because iodine can be absorbed through the lining, and pregnancy is another reason to speak up so the team can choose. If mupirocin is chosen, ask for the nasal product rather than the skin tube.