Randomized Controlled Trial of Standard Versus Systemic Decolonization Therapy for the Eradication of Methicillin-resistant Staphylococcus Aureus (MRSA) Colonization

MRSA decolonization may reduce the risk of subsequent MRSA infection and further transmission. A recent randomized controlled trial demonstrated that systemic decolonization may be safe and effective among hospitalized patients when compared to no treatment. As a large number of the investigators patients require re-admission and further transmission may take place in the community, the investigators are comparing the standard decolonization protocol for MRSA eradication to the systemic decolonization protocol among an ambulatory population.

Standard decolonization protocols, which use only topical agents, are limited in efficacy. The method of systemic decolonization to be studied here appears to have greater efficacy than the standard approach using only topical agents. However, concerns have been raised that the increased use of systemic antibiotics may lead to increased levels of drug resistance adverse effects, without sustained decolonization. This study seeks to provide further data to help answer these questions and provide guidance for further policy development and implementation.

• Drug: Rifampin
  600mg po once daily x 7 days
• Drug: Doxycycline
  100mg po twice daily x 7 days
• Other: 2% mupirocin ointment
  ~ 1cm applied to the anterior nares twice daily for 7 days
• Other: 4% chlorhexidine gluconate
  Daily full body wash (including hair) for 7 days

• Experimental: Systemic decolonization
  7-day course of 4% chlorhexidine gluconate daily washes and 2% mupirocin ointment to the anterior nares twice daily in addition to oral rifampin (600mg daily), and doxycycline (100mg twice daily)
  Interventions:

  • Drug: Rifampin
  • Drug: Doxycycline
  • Other: 2% mupirocin ointment
  • Other: 4% chlorhexidine gluconate
• Active Comparator: Standard decolonization
  7-day course of 2% mupirocin ointment to the anterior nares twice daily and 4% chlorhexidine gluconate washes once per day.
  Interventions:

  • Other: 2% mupirocin ointment
  • Other: 4% chlorhexidine gluconate

Inclusion Criteria:

• Any patient colonized with MRSA

Exclusion Criteria:

• Currently on treatment with antibiotics
• Pregnant or breastfeeding women
• Active infection
• Hepatic cirrhosis or abnormal INR due to liver disease
• Decolonization in the previous two (2) months
• MRSA bacteria resistant to one or more of the study medications
• AST and ALT levels more than five times the upper limit of normal.