Neomycin with chlorhexidine hydrochloride

(0.5% + 0.1%)

• Nasal cream (£1.99 = 15g)

Indications

• Treatment and prevention of nasal staphylococci
• Recurrent epistaxis in children and adults (unlicensed indication)

Dose

• Eradication of staph: Apply four times daily for 10 days
• Prevention of nasal carriage of staph: Apply twice daily

Notes

1. Healthcare professional communication (April 2023): Extra care regarding patient allergy status must be taken when prescribing and dispensing Naseptin nasal cream. Both the original formulation containing Arachis oil and a revised formulation without Arachis oil will be in circulation in the supply chain from April 2023 until November 2025. Verify if the patient has an allergy to peanut or to soya – if so, take care to dispense only the Arachis oil-free formulation.

Mupirocin

• Nasal ointment 2% (£4.24 = 3g)

Indications

• Decolonisation of MRSA

Dose

• Apply 2-3 times a day

Notes

1. Mupirocin nasal should ideally be kept in reserve to avoid resistance developing. It is part of the recommended MRSA decolonisation regimen used for patients colonised with MRSA who are referred for surgical procedures (see Skin and soft tissue infections). In such cases, please seek advice from Infection Control or Microbiology.

Epistaxis

Most epistaxis is self-limiting and harmless, and often the cause of damage to the blood vessels is not identified. Children with recurrent epistaxis may be prescribed chlorhexidine with neomycin (unlicensed indication, contains peanut oil). Apply for 4 weeks. Consider for cauterisation if no improvement after 4 weeks.