Emergence of resistance during mupirocin treatment: is it a problem in clinical practice?

Mupirocin (pseudomonic acid A) is indicated for primary and secondary skin infections, and for the eradication of nasal colonization of Staphylococcus aureus, particularly methicillin-resistant S. aureus (MRSA). This paper reviews the mechanisms by which resistance to mupirocin can develop, discusses clinically relevant breakpoints, and the clinical significance of reports of resistance. Following more than 10 years' use, short courses of treatment, even when repeated, are associated with remarkably little resistance and this resistance is unlikely to be clinically significant.