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Perianal candidosis--a comparative study with mupirocin and nystatin.
Int J Dermatol. 1999 Aug; 38(8):618-22.IJ

Abstract

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 albicans to 2% mupirocin, nystatin, and five additional antifungal agents was evaluated using the Nathan agar-well diffusion assay. The minimum inhibitory concentration (MIC) of mupirocin against the Candida species was determined using a tube dilution method. In vivo. Twenty patients (mean age, 12 months; range, 1 month to 4 years) with moderate to severe Monilia diaper dermatitis either had mupirocin ointment or nystatin cream applied to the infected area every 8 h or after every diaper change for a period of 7 days. Microscopic examination of skin scrapings and mycologic and microbiological cultures were performed before treatment and daily for 7 days, and progress was clinically assessed.

RESULTS

In vitro. Topical mupirocin produced a greater zone of inhibition than nystatin cream, i.e. a mean of 27.2 mm (SD 1.55) compared with a mean of 17.3 mm (SD 1.08) for nystatin cream. MIC for mupirocin of 512 microg/mL in one case, 256 microg/mL in six cases, 200 microg/mL in 10 cases and 400 microg/mL in three cases were obtained for the 20 clinical isolates. C. albicans also displayed a universal sensitivity to mupirocin and nystatin. In vivo. Eradication 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-negative bacteria were eradicated from the infected area within the trial period. 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 seven wounds showed evidence of improved, but ongoing excoriated dermatitis and 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 excellent antifungal agent.

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Authors+Show Affiliations

de Wet PM
Department of Paediatric Surgery, Institute of Child Health, Red Cross War Memorial Children's Hospital, Rondebosch, South Africa.
Rode H
No affiliation info available
van Dyk A
No affiliation info available
Millar AJ
No affiliation info available

MeSH

Administration, TopicalAnal CanalAnti-Bacterial AgentsAntifungal AgentsCandida albicansCandidiasisChild, PreschoolDiaper RashFemaleFollow-Up StudiesHumansInfantInfant, NewbornMaleMicrobial Sensitivity TestsMupirocinNystatinTreatment Outcome

Pub Type(s)

Clinical Trial
Comparative Study
Journal Article
Randomized Controlled Trial

Language

eng

PubMed ID

10487455

Citation

de Wet, P M., et al. "Perianal Candidosis--a Comparative Study With Mupirocin and Nystatin." International Journal of Dermatology, vol. 38, no. 8, 1999, pp. 618-22.
de Wet PM, Rode H, van Dyk A, et al. Perianal candidosis--a comparative study with mupirocin and nystatin. Int J Dermatol. 1999;38(8):618-22.
de Wet, P. M., Rode, H., van Dyk, A., & Millar, A. J. (1999). Perianal candidosis--a comparative study with mupirocin and nystatin. International Journal of Dermatology, 38(8), 618-22.
de Wet PM, et al. Perianal Candidosis--a Comparative Study With Mupirocin and Nystatin. Int J Dermatol. 1999;38(8):618-22. PubMed PMID: 10487455.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Perianal candidosis--a comparative study with mupirocin and nystatin. AU - de Wet,P M, AU - Rode,H, AU - van Dyk,A, AU - Millar,A J, PY - 1999/9/16/pubmed PY - 1999/9/16/medline PY - 1999/9/16/entrez SP - 618 EP - 22 JF - International journal of dermatology JO - Int J Dermatol VL - 38 IS - 8 N2 - 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 albicans to 2% mupirocin, nystatin, and five additional antifungal agents was evaluated using the Nathan agar-well diffusion assay. The minimum inhibitory concentration (MIC) of mupirocin against the Candida species was determined using a tube dilution method. In vivo. Twenty patients (mean age, 12 months; range, 1 month to 4 years) with moderate to severe Monilia diaper dermatitis either had mupirocin ointment or nystatin cream applied to the infected area every 8 h or after every diaper change for a period of 7 days. Microscopic examination of skin scrapings and mycologic and microbiological cultures were performed before treatment and daily for 7 days, and progress was clinically assessed. RESULTS: In vitro. Topical mupirocin produced a greater zone of inhibition than nystatin cream, i.e. a mean of 27.2 mm (SD 1.55) compared with a mean of 17.3 mm (SD 1.08) for nystatin cream. MIC for mupirocin of 512 microg/mL in one case, 256 microg/mL in six cases, 200 microg/mL in 10 cases and 400 microg/mL in three cases were obtained for the 20 clinical isolates. C. albicans also displayed a universal sensitivity to mupirocin and nystatin. In vivo. Eradication 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-negative bacteria were eradicated from the infected area within the trial period. 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 seven wounds showed evidence of improved, but ongoing excoriated dermatitis and 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 excellent antifungal agent. SN - 0011-9059 UR - https://www.unboundmedicine.com/medline/citation/10487455/Perianal_candidosis__a_comparative_study_with_mupirocin_and_nystatin_ L2 - https://onlinelibrary.wiley.com/resolve/openurl?genre=article&sid=nlm:pubmed&issn=0011-9059&date=1999&volume=38&issue=8&spage=618 DB - PRIME DP - Unbound Medicine ER -