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Staph Aureus in the Nose

A study from Japan showed that 44 percent of people with constant stuffy noses carry the bacteria, staph aureus, in their noses (18). Some people carry a bacteria called staph aureus in their noses, even though it may cause no nasal symptoms (1). They are at increased risk for not healing when they cut themselves or have surgery (2), having sore nipples when they breast feed (3), and being unable to control skin diseases such as eczema and psoriasis (4,5,6). Your doctor usually treats skin infections with antibiotic pills and injections, which readily clear germs from the skin, but oral and injected antibiotics rarely clear staph aureus from your nose. (7) Then, after treatment, staph aureus returns to your skin to start another infection. Surgeons who have staph aureus in their noses are usually not allowed to operate because the germ can get into surgical wounds and delay healing.

Most of the time, you can clear staph aureus from your nose by applying a bacitracin, mupiricin or combination antibiotic ointment in your nose at bedtime for several weeks. You can buy inexpensive bacitracin ointment without a prescription and apply a small amount inside your nostrils for several weeks. Many doctors prescribe the far more expensive prescription ointment, mupiricin, because of the intense publicity that has been generated for its use (8,9,10,11,12,13,14, 16). Some people have had to apply an antibiotic ointment into their noses for five days each month for one year to be cured (15). If you have a resistant staph aureus, cultures will tell you what antibiotic to use. Sometimes, you may need to use intravenous vancomycin.

1) MW Casewell. The nose: an underestimated source of Staphylococcus aureus causing wound infection. Journal of Hospital Infection 40: Suppl. B (SEP 1998):S3-S11.

2) RP Wenzel, TM Perl. The significance of nasal carriage of Staphylococcus aureus and the incidence of postoperative wound infection. Journal of Hospital Infection 31: 1 (SEP 1995):13-24.

3) VH Livingstone, CE Willis, J Berkowitz. Staphylococcus aureus and sore nipples. Canadian Family Physician 42 (APR 1996):654-659.

4) P Strange, L Skov, S Lisby, PL Nielsen, O Baadsgaard. Staphylococcal enterotoxin B applied on intact normal and intact atopic skin induces dermatitis. Archives of Dermatology 132: 1 (JAN 1996):27-33.

5) H Akiyama, J Tada, Y Toi, H Kanzaki, J Arata.Changes in Staphylococcus aureus density and lesion severity after topical application of povidone-iodine in cases of atopic dermatitis. Journal of Dermatological Science 16: 1 (NOV 1997):23-30.

6) F Giordanolabadie. Infectious complications of atopic dermatitis. Revue Francaise D Allergologie et D Immunologie Clinique 38: 4 (1998):345-348. Staphylococcus aureus superinfections are the most frequent.

7) Archives of Internal Medicine July 11, 1994.

8) Archives of Internal Medicine July 11, 1994.

9) C Brunbuisson, A Rauss, P Legrand, H Mentec, M Ossart, F Eb, JP Sollet, F Leturdu, A Boillot, Y Michelbriand, JL Ricome, A Boisivon. Mupirocin Treatment of S Aureus Nasal Carriage and Prevention of Infection in Intensive Care Units: A Multicenter Controlled Study. Medecine et Maladies Infectieuses 24: 12 (DEC 1994):1229-1239.

10) C Watanakunakorn, C Axelson, B Bota, C Stahl. Mupirocin ointment with and without chlorhexidine baths in the eradication of Staphylococcus aureus nasal carriage in nursing home residents. American Journal of Infection Control 23: 5 (OCT 1995):306-309.

11) LA Herwaldt. Reduction of Staphylococcus aureus nasal carriage and infection in dialysis patients. Journal of Hospital Infection 40: Suppl. B (SEP 1998):S13-S23.

12) J Kluytmans. Reduction of surgical site infections in major surgery by elimination of nasal carriage of Staphylococcus aureus. Journal of Hospital Infection 40: Suppl. B (SEP 1998):S25-S29.

13) P Davey. Eradication of nasal carriage of Staphylococcus aureus - is it cost-effective? Journal of Hospital Infection 40: Suppl. B (SEP 1998):S31-S37.

14) S Mehtar. New strategies for the use of mupirocin for the prevention of serious infection. Journal of Hospital Infection 40: Suppl. B (SEP 1998):S39-S44.

15) R Raz, D Miron, R Colodner, Z Staler, Z Samara, Y Keness. A 1-year trial of nasal mupirocin in the prevention of recurrent staphylococcal nasal colonization and skin infection. Archives of Internal Medicine 156: 10 (MAY 27 1996):1109-1112.

16) T Hayakawa, T Hayashidera, S Katsura, K Yoneda, T Kusunoki. Nasal mupirocin treatment of pharynx-colonized methicillin resistant Staphylococcus aureus: Preliminary study with 10 carrier infants. Pediatrics International, 2000, Vol 42, Iss 1, pp 67-70.

17) K Breuer, M Wittmann, B Bosche, A Kapp, T Werfel. Severe atopic dermatitis is associated with sensitization to staphylococcal enterotoxin B (SEB). Allergy, 2000, Vol 55, Iss 6, pp 551-555.

18) T Shiomori, S Yoshida, H Miyamoto, K Makishima. Relationship of nasal carriage of Staphylococcus aureus to pathogenesis of perennial allergic rhinitis. Journal of Allergy and Clinical Immunology, 2000, Vol 105, Iss 3, pp 449-454.

Checked 7/6/13

May 30th, 2013
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About the Author: Gabe Mirkin, MD

Sports medicine doctor, fitness guru and long-time radio host Gabe Mirkin, M.D., brings you news and tips for your healthful lifestyle. A practicing physician for more than 50 years and a radio talk show host for 25 years, Dr. Mirkin is a graduate of Harvard University and Baylor University College of Medicine. He is board-certified in four specialties: Sports Medicine, Allergy and Immunology, Pediatrics and Pediatric Immunology. The Dr. Mirkin Show, his call-in show on fitness and health, was syndicated in more than 120 cities. Read More
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