Staphylococcal Nasal Carriage

Comments from Expert Advisory Group

  • Staphylococcus aureus nasal carriage is common - approximately 20% of individuals almost always carry one strain, with many more transiently colonised
  • Treatment in all colonised patients is not required
  • Nasal Staphylococcus aureus colonisation, may act as a reservoir in cases of recurrent staphylococcal infection
  • In recurrent staphylococcal infection, nasal swabbing may be indicated, and suppression as per the table below initiated, depending on swab results
  • Cases of recurrent or persistent infection, despite nasal staphylococcal decolonisation, may warrant consideration of alternative causes of infection, and referral to secondary care as appropriate
  • Panton-Valentine Leukocidin (PVL) is a toxin produced by 2% of Staphylococcus aureus and is associated with persistent recurrent pustules and carbuncles or cellulitis. Send swabs for culture in these clinical scenarios as well as nasal swab for Staphylococcus aureus carriage. On rare occasions it causes more severe invasive infections, even in otherwise fit people. Risk factors include nursing homes, contact sports, sharing equipment, poor hygiene and eczema

Staphylococcal Nasal Carriage

Drug Dose Duration +/- Notes
First choice option

Chlorhexidine 0.1% + Neomycin Sulphate 0.5% (Naseptin®)

Apply to the inside of each nostril every 6 hours

10 days

Apply by placing a small amount of the cream onto the little finger and applying to the inside of the nostril. Nostrils can be “squeezed”, by pressing the sides of the nose together after application to aid spread of ointment

A cotton bud may be used for application if needed

 

 
MRSA Suppression

Mupirocin (Bactroban®)

Apply to the inside of each nostril every 8 hours

5 days

Safe Prescribing (visit the safe prescribing page)

  • Doses are oral and for adults unless otherwise stated
  • Safety in Pregnancy and Lactation
  • Visit the Health Products Regulatory Authority (HPRA) website for detailed drug information (summary of product characteristics and patient information leaflets). Dosing details, contraindications and drug interactions can also be found in the Irish Medicines Formulary (IMF) or other reference sources such as British National Formulary (BNF) / BNF for children (BNFC).

Reviewed March 2023

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