Bactroban (Mupirocin) vs Neosporin: A detailed comparison

This post compares used, benefits and side effects of bactroban (mupirocin) vs neosporin, popular ointments (topical medications) used for treatment of skin infection.

Are blisters appearing on your skin after your last visit to the gym? Is your knee that you scraped while playing football not healing? There is a large probability that your skin has become infected with bacteria. Bacteria are disease causing microbes and are present everywhere in our environment. If not treated, bacterial infections can aggravate. Our skin is exposed to these microbes all the time as it outermost covering of our body and risk of catching an infection is increased when our skin is bruised or wounded. Luckily, there are medicines available to counter bacterial attacks. These are called antibiotics.

Natural antibiotics are derived from one microorganism and used to eliminate the other. Synthetic antibiotics are also being manufactured. For treating bacterial skin ailments, antibiotic ointments are used. Ointments are topical medications applied to body surface and skin to treat various medical conditions. There are many antibiotic ointments available at medical stores. Each ointment has its own specific uses. Two popular antibiotic topical medications, Bactroban and Neosporin are discussed below. It is important to know characteristic features, actions, uses and side effects of each to evaluate which one will suit your needs.  Overuse or unnecessary use of antibacterial medications can build resistance in bacteria in your body towards antibiotics and it becomes increasingly tougher to fight bacterial diseases.

Bactroban

Bactroban (Mupirocin) cream and ointment is an antibacterial medicine used to counter certain skin infections caused by bacteria. It is particularly effective against mischief caused by methicillin resistant Staphylococcus aureus (MRSA).

Core component

The chief active ingredient of Bactroban is mupirocin. It is an antibacterial agent produced naturally by fermentation using organism Pseudomonas fluorescens. It is active against large range of gram positive bacteria and certain gram negative bacteria. It is a mixture of several pseudomonic acids.

At low conditions it is bacteriostatic that is it stops bacteria from further multiplying. At high concentrations it is bactericidal and aborts infection causing bacteria.

It is inactive against many anaerobic bacteria, mycobacteria, yeast and fungi. (1)

It is enlisted among World Health Organization’s List of Essential Medicines. (2)

Methycillin resistant Staphylococcus aureus (MRSA)

This bacterium is target prey of Bactroban and is responsible for several difficult to treat infections in humans. MRSA is any bacterium that through process of natural selection has developed resistance to beta-lactam antibacterial agents such as penicillins and cephalosporins.  This resistance does not enhance its disease causing capability, rather it makes MRSA infection more difficult to treat and therefore more dangerous.  This bacterium mostly settles down under the anterior nares or nostrils. (3)

Airways, respiratory passages, urinary tract are potential sites for infection too. In most cases, MRSA is detected by swabbing nostrils and isolating bacteria in nostrils. Screening of patients along with extra sanitary precautions has been found to be effective in preventing open wound infections.

Risk factors

People most vulnerable to infections caused by MRSA are:

Hospital patients

Hospitals are a hotspot of germs. It is very easy to contract infections there. Patients in surgical wards recovering from surgery, patients with wounds and broken skin are especially at risk of catching a bacterial infection. Mostly, MRSA infections occur in hospitals and medical centers. Healthcare professional to patient transfer of infection is common especially when safety precautions are neglected such as washing hands. Hospital patients on quinolone medication are also at risk. Case-control studies examining risk factors for MRSA have found an important link between fluoroquinolone exposure and MRSA infections. Initially it was thought that quinolones are effective in preventing these infections. But it was gradually observed that MRSA is resistant to quinolones like ciprofloxacin and levofloxacin. (4, 5).

Prison inmates, military personnel and homeless people

Prisons, military barracks and camps and shelters for homeless people can be crowded putting inhabitants at greater risk of contracting MRSA infection. Usually poor hygienic conditions prevail in these places making people more vulnerable to MRSA infection. In prison, inmates share clothes, tools and utensils exposing them to risk of infection. Injured soldiers reside in same camp as healthy soldiers and put them at risk of infection. Homeless people sleep on sidewalks and hunt for food and clothing through garbage dumps and have an unhygienic lifestyle that makes them an easy target for infection. (6)

Athletes

Locker rooms and gyms are potential sites for MRSA contamination and infection. Incidence of these infections has been found to be high among athletes. Athletes share locker rooms and often are injured during games and matches. MRSA bacteria are abundant in sports fields and players easily contract infection there.

Children

Spread of contagious MRSA infections in pediatric settings is a critical problem. Children regularly come in contact with MRSA bacteria at day care centers, playgrounds, camps, dormitories and parks. Parents should especially be cautious about their child’s health where toys or sports equipment is shared.

Consequences

MRSA takes typically 24-48 hours to manifest its symptoms. After 3 days or 72 hours, MRSA settles down in human tissues and becomes highly resistant to treatment. Initial manifestations of MRSA infection are small red bumps, spider bites, accompanied by pyrexia or fever and sometimes rashes. After a few days, bumps aggravate, become larger and spread. They eventually open into deep, pus filled boils.

Medical uses

Bactroban (Mupirocin) ointment is used to treat following skin conditions (7, 8, 9, 10):

Impetigo

Impetigo is a highly contagious skin infection especially rampant among children caused by S. aureus and S.pyogenes. Athletes and jocks that play close contact sports such as basketball, rugby, boxing, etc. are also an easy target of this disease. It is also termed as school sores. This infection occurs more frequently during warm weather. Secondary skin infections of skin lesions already present can also occur (for example cuts, abrasions, insect bites, chickenpox pustules).

It is spread from person to person by direct contact with skin lesions. Scratching may aggravate lesions.  There are various types of impetigo:

• Impetigo Contagiosa: It is also known as non-bullous impetigo and is common type of impetigo among kids. Its initial symptoms appear as red sores around nose and mouth. Children with this condition have multiple coalescing lesions on face and extremities. Initial lesions are tiny vesicles or pustules. Eventually, these blisters burst open, leaving a seething red rash that becomes crusted. This rash is itchy but not painful. Swollen lymph nodes may also accompany the rashes.
• Bullous impetigo: It is most frequently observed in children below two years of age. Blisters usually develop initially on abdomen, arms and legs. They first appear clear and then turn cloudy. They are filled with a clear yellow fluid that turns cloudy and dark yellow. Blisters in this infection last longer than in other types of impetigo.
• Ecythma: This is severe form of impetigo because it not only affects topmost layer of skin, but also the one underlying it. The blisters permeate deep into dermis and are very painful. They may turn into skin ulcers or sores. Swollen lymph nodes and scarring may also accompany blisters.

Folliculitis

It is inflammation and infection of hair follicles. This skin infection can occur anywhere on your body except soles of feet and palms of hands.

Signs and symptoms

• Rashes on affected area.
• Itchy skin
• Pimples or pustules erupt around hair follicle at infected area.
• Mostly occur on neck, armpits or groin area.

Bacterial agents involved in spread of folliculitis

• Hot tub folliculitis is caused by Pseudomonas aeruginosa. This infection occurs by sitting in a hot tub that is unhygienic. Symptoms appear at body parts that are placed in hot tub – typically the legs, buttocks, thighs. Symptoms are aggravated when wet clothing such as bathing suits or wet towels are placed over affected area.
• Barber’s itch is caused by staphylococcus bacteria on bearded and hair covered areas of face.

Furunculosis

It is a deep infection of hair follicles. Abscesses are formed with pus and necrotic tissue. Furunculosis is characterized by boils over skin. It is a recurring infection. Pus filled abscesses are formed over patient’s skin. Sometimes, furuncles or nodules merge to form a bigger nodule. Recurrent attacks take place usually within 12 months 3 or 4 times. Bacteria usually settle in under nostrils but also colonize in warm, moist folds of skin such as behind ears and under folds of groin. Complications may lead to permanent scarring.

It is used to treat bacterial infections in open wounds and traumatic lacerations.

Mode of action

Mupirocin, active ingredient present in Bactroban, attaches to t-RNA synthetase in Staphylococcus aureus and Streptococcus, resulting in blocking of protein synthesis. DNA and cell wall formation are also disintegrated (11).

Side effects

The adverse effects of Bactroban on patient are as follows (12):

Local

Local adverse effects associated with use of Bactroban are:

• Itching
• Pain
• Stinging
• Burning

Gastrointestinal

Gastrointestinal side effects are rare but include abdominal cramps, nausea and vomiting.

Ocular side effect caused by Bactroban is blepharitis.

Dermatological

Dermatological side effects caused by Bactroban are eczema, pain, bleeding, cellulitis, dermatitis, hives and rash.

Precautions

Before starting use of Bactroban, get your skin infection checked by a dermatologist as some infections aggravate if treated with wrong antibacterial medication. Determine if you are allergic to mupirocin or polyethylene glycol present in this ointment. Hypersensitivity to any ingredient in ointment can trigger contact dermatitis.

During your consultation with dermatologist, provide him with complete details of your medical history.

Bactroban cream and ointment is for external use and topical application only. It should not be confused with nasal ointment containing mupirocin used to eradicate bacteria from inside nose.

Avoid getting ointment into your eyes or mouth. If it gets in your eyes rinse them with cold water repeatedly till irritation subsides.

Bactroban ointment contains polyethylene glycol which can permeate open wounds and is excreted by kidneys. People with history of even mild renal dysfunction should avoid using this ointment.

The safety of using this ointment while pregnant has not been established yet. Pregnant women should not use this cream without consulting their doctor.

This ointment is not suitable for use on mucosal surfaces.

It is safe for use for children of 2 months and above.

How to use Bactroban ointment

Use ointment according to instructions and dosage prescribed by your doctor.

Apply thin layer of ointment over affected and infected areas three times a day for a period of ten days. A dressing or bandage can be placed over this layer if needed.

Wash your hands carefully after applying this ointment.

Do not use medicine for longer than ten days as bacteria might develop resistance to mupirocin present in Bactroban. If your infection does not seem to be getting better or symptoms persist consult your doctor about continuing your medication.

Prolonged use may lead to growth of non-susceptible organisms such as fungi.

Store this ointment at room temperature and keep it well out of reach of children who might accidentally ingest it.

Neosporin

Neosporin is an antibiotic medicine prepared for prevention of infection and for healing of wounds.

Core components

Components of Neosporin are as follows (13, 14):

Neomycin sulphate

Neomycin is a widely used antibiotic component in topical ointments and eye drops. It was discovered in 1949 by Selman Walksman. It belongs to aminoglycoside class of antibiotics. These are antibacterial agents that contain two or more aminosugars linked by glycosidic bonds. Neomycin is extremely efficient against gram negative bacteria.

Mechanism of action

This drug abolishes bacteria by stopping production of essential proteins required by bacteria to survive and thrive.

Side effects

It is a highly nephrotoxic agent and may cause severe damage to kidneys especially if used orally.

Polymyxin B

Polymyxin B is an antibacterial agent derived from bacterium Bacillus polymyxa mostly used for resistant gram-negative infections.

Mechanism of action

It alters and makes outer bacterial membrane more permeable. Alteration takes place by binding to a negatively charged site in lipopolysaccharide layer. This layer has an electrostatic attraction for amino groups which are positively charged and binding site for calcium and magnesium counter ions. This results in a destabilized membrane.
 

Thus membrane integrity is compromised and toxic substances freely enter and bacteria are killed.

Side effects

Allergic reaction to this mixed antibiotic may produce itching, redness of skin and welts.

Pramocaine

Pramocaine is a topical anesthetic used to counter itching. It is used widely in ointments because of its low toxicity. It is well tolerated by most mucous membranes. It is used to provide relief sunburn, minor burns, itching and numbing pain in insect bites, stinging by poisoned ivy and minor cuts.

Mechanism of action

Pramocaine or paramoxine HCL decreases permeability of neuronal membranes to sodium ions, blocking nerve impulse conduction. It thus acts as an anesthetic agent.

Bacitracin

Bacitracin is a bactericidal mixture that eliminates both gram negative and gram positive bacteria. It is produced by organisms of the licheniformis group of Bacillus subtilis var Tracy. It is used in topical preparations because it is highly toxic when ingested and causes kidney damage. It disrupts cell wall synthesis and integrity of bacteria it targets.

Vitamin E

Vitamin E added in Neosporin repairs injured tissue. It is an anti oxidizing agent that shield and repairs skin. It is a peroxyl radical hunter. It disables production of toxic free radical in tissues, by reacting with them to form a tocopheryl radical which is then reduced by a hydrogen donor.  It also prevents scar formation. (15)

Other components include cocoa butter, cottonseed oil, petroleum jelly, etc.

Medical uses

Neosporin ointment is used to treat following dermatological conditions:

• Minor wounds
• Cut, scrapes, burns
• Prevent or treat skin infections.

Neosporin against acne

There are different views about using Neosporin for treatment of acne. As it contains antibiotic agents many consumers assume that it will work againt acne caused by bacteria. But that is not the case.

• Polmyxin B sulphate is an antibiotic agent that targets gram negative bacteria. These bacteria mostly infect wounds. They rapidly become resistant to antibiotics that is why Neosporin should not be used for prolonged period of time whereas acne treatment is a lengthy process and may take weeks, even months. Furthermore, acne causing bacteria Propionibacterium acnes is a gram positive bacteria.
• Bacitracin does work against gram positive bacteria but it targets S aureus and streptococci. It only works superficially so it cannot penetrate skin deep enough to treat acne.
• Zinc is present in Neosporin as well but it is effective against acne when taken orally, not topically. Oral antibiotics are more effective in treating acne.
• Neomycin is a poor choice for acne treatment because skin prone to acne is already sensitive and this agent can cause further irritation and redness.
• Ingredients like olive oil, cocoa butter and petroleum jelly cause more secretion of oil from skin and clog pores thus making it more prone to acne break outs.
• Neosporin however is good for spot treatment after popping a zit as it contains vitamin E and skin healing components.

Side effects

Patients rarely experience any adverse effects of using Neosporin. Side effects observed are (16):

• Skin rash
• Scaling
• Welts
• Redness
• Eruption of hives

If any of these symptoms appear, stop using this ointment and consult your doctor. Ask him to prescribe you another ointment.

Precautions

Unpleasant consequences may occur if some medical conditions interact with use of Neosporin. Tell your dermatologist or doctor about your medical history or any existing medical conditions that you may have.

• Absorption: Sure, this is a topical ointment but still a small fraction of it is absorbed by blood stream and may reach kidneys or other organs and cause harm. So avoid using large amounts on your skin without prior consultation with a doctor.
• Pregnancy: Patients are advised against using this medicine during pregnancy and nursing as it may pass into milk.
• Kidney function: The antibiotic components of this ointment are very toxic for kidneys. For renal patients a small dosage is recommended as some amount of ointment is absorbed into blood.
• Allergies: People prone to eczema, skin ulcers or swimmer’s ears are more likely to develop an allergic reaction while using this ointment. If your skin becomes red, swollen and itchy, contact your doctor immediately.
• Overgrowth of organisms: Prolonged use of this medication may cause growth of undesired microorganisms that this medication cannot counter.
• Children: This ointment is not recommended for children below 2 years of age because they have sensitive skin and more ointment is absorbed. Furthermore, infants may ingest the ointment by mistake.
• Seniors: Elderly patients frequently suffer from renal disorders so they should only be given a small dosage of this ointment to avoid side effects on kidneys.
• Drug interactions: Patients using neuromuscular blocking agents are advised against using this ointment because of possible drug interaction. Consult with your doctor and replace one of your medications.

How to use Neosporin

Clean affected area before applying this ointment and clean any pus, blood or debris. Apply pea sized amount over affected area and rub gently until it is absorbed. Cover treated area with bandage or plaster if required. Wash your hands carefully after using this ointment, especially if you are about to eat something.

Do not apply Neosporin over large area of your body without consulting your doctor first.

This ointment is for external use only. Avoid getting it into your nose, eyes or mouth. If it gets into your eyes, rinse them immediately with cold water.

Use it 2-5 times daily. It should not be used for more than seven days. If your skin wound does not heal after a week, consult your doctor.

Store this medication at room temperature and keep it out of reach of children.

Different dosage is required for different age groups. Do not give your ointment to anybody else to use without getting them checked by a doctor. Using this ointment unnecessarily will cause more harm than good.

Bactroban vs Neosporin: comparison

Bactroban and Neosporin both are antibiotic ointments so it is easy to get confused when you are standing at a drug store wondering which medicine to buy. You have been provided with full information regarding these two above so it will be easy for you to decide which one best suits your medical needs.

A comparison of these two widely used skin ointments is as under:

Core ingredients

Core ingredient of Bactroban is muciprocin while core ingredient of Neosporin is neomycin sulphate. Both these drugs have different bactericidal actions. Bactrobran has a single active ingredient while Neosporin is a mixture antibiotic ointment.

Target bacteria

Bactroban is active mostly against gram positive bacteria especially methicillin resistant Staphylococcus aureus (MRSA). Neosporin on the other hand is ointment of choice while suffering from infection caused by gram negative bacteria.

Modes of action

Bactroban kills target bacteria by blocking protein synthesis. It binds to t-RNA synthetase enzyme and blocks protein synthesis in S. aureus and Streptococcus while Neosporin primarily acts by disintegrating cell membrane of bacteria and making them more vulnerable to external toxins.

Medical uses

Bactroban is used to treat contagious bacterial infections such as impetigo and folliculitis. These diseases are mostly caused by visits to hospital, parks, and playgrounds. Neosporin is used to treat bacterial infections caused by gram negative bacteria, to treat skin wounds, burns, insect bites and for repair of skin.

Side effects

Side effects of using Bactroban include nausea, vomiting, contact dermatitis. A small amount of this antibiotic may be absorbed in bloodstream and cause an intestinal disorder Clostridium difficile-associated diarrhea. Side effects of Neosporin are skin rash, hives, welts and redness. It has toxic effects on kidney if used in large amounts.

Precautions

Bactroban is not recommended for use on mucosal surfaces. Neosporin on the other hand is well tolerated by mucosal surfaces.

It is important that you carefully select an antibiotic ointment for skin conditions especially contagious infections because unnecessary use of antibacterial medicines can build up resistance in bacteria and it will become increasingly difficult to treat them. Neosporin is easily available over the counter but it is advised that you only use it after consulting with your doctor because of its toxic effects on kidneys. Bactroban is used to treat bacterial infections that spread quickly and if misused it can cause contact dermatitis. The selection of ointment also depends upon age and medical history of patient. So, do not skip a visit to your doctor before heading over to your nearest medical store.

If blisters and lesions are appearing on your skin after a tennis match with your buddies and a day at the gym, Bactroban will be the solution to your problems. If an insect has bitten you or you have scraped your hand on a barbed wire, Neosporin is the ointment you should use.