Perianal candidosis - a comparative study with mupirocin and nystatin

Objective To assess the efficacy and clinical outcome of 2% mupirocin in a polyethylene glycol base and nystatin cream as treatment regimens in diaper candidosis. Design A prospective randomized comparative study. Methods In vitro. The susceptibility of 20 clinical isolates of Candida alb icans to 2% mupirocin, nystatin, and five additional antifungal agents was evaluated using the Nathan agar-well diffusion assay. The minimum inhibitor y concentration (MIC) of mupirocin against the Candida species was determin ed using a tube dilution method. In vivo. Twenty patients (mean age, 12 mon ths; range, 1 month to 4 years) with moderate to severe Monilia diaper derm atitis either had mupirocin ointment or nystatin cream applied to the infec ted area every 8 h or after every diaper change for a period of 7 days. Mic roscopic examination of skin scrapings and mycologic and microbiological cu ltures were performed before treatment and daily for 7 days. and progress w as clinically assessed. Results In vitro. Topical mupirocin produced a greater zone of inhibition t han nystatin cream, i.e. a mean of 27.2 mm (SD 1.55) compared with a mean o f 17.3 mm (SD 1.08) for nystatin cream. MIC for mupirocin of 512 mu g/mL in one case, 256 mu g/mL in six cases, 200 mu g/mL in 10 cases and 400 mu g/m L in three cases were obtained for the 20 clinical isolates. C. albicans al so displayed a universal sensitivity to mupirocin and nystatin. In vivo. Er adication of all Candida organisms was achieved within 2-6 days (mean, 2.6 days) in 10 patients receiving topical mupirocin therapy with rapid healing of the excoriated wounds (mean, 4.7 days). Both Gram-positive and Gram-neg ative bacteria were eradicated from the infected area within the trial peri od. Ten patients received topical nystatin cream and, in each case, Candida was successfully cleared within 5 days (mean, 2.8 days). Only three wounds were clinically healed within the trial period, however. The remaining sev en wounds showed evidence of improved, but ongoing excoriated dermatitis an d a heavy growth of polymicrobial organisms. Conclusions Both agents eradicated Candida, the major difference being the marked response of the diaper dermatitis to mupirocin. Mupirocin should be applied topically 3-4 times daily or with each diaper change and is an exce llent antifungal agent.