Usage
Bromelain + Mupirocin is a topical combination medication primarily used for bacterial skin infections, such as impetigo, folliculitis, furunculosis, and secondarily infected traumatic skin lesions.
-
Pharmacological Classification: Antibiotic (Mupirocin), Proteolytic enzyme (Bromelain)
-
Mechanism of Action: Mupirocin exerts its antibacterial effect by inhibiting bacterial protein and RNA synthesis, specifically targeting bacterial isoleucyl-tRNA synthetase. Bromelain, a proteolytic enzyme, aids in the removal of dead or damaged skin cells, promoting healing and reducing inflammation at the application site.
Alternate Names
- Bromelain + Mupirocin Ointment
- Epicin-B Ointment
- Enzoheal Ointment
- Enzomac Ointment
- Dres Ointment
Several brand names exist for this combination product, including Enzoheal, Epicin B, Dres Ointment, Multiheal, and Mupitone-B.
How It Works
-
Pharmacodynamics: Mupirocin acts as a topical antibiotic, preventing bacterial growth by binding to isoleucyl-tRNA synthetase. This inhibits protein and RNA synthesis in susceptible bacteria. Bromelain enhances healing by breaking down proteins and removing damaged tissue, thereby reducing inflammation.
-
Pharmacokinetics: Mupirocin, applied topically, has minimal systemic absorption. Bromelain’s topical absorption is limited. Systemically administered bromelain is absorbed orally and metabolized renally and perhaps hepatically.
-
Mode of Action: Mupirocin targets bacterial isoleucyl-tRNA synthetase, leading to the disruption of protein and RNA synthesis in bacteria. Bromelain, a proteolytic enzyme, breaks down proteins involved in inflammation and tissue damage. Elimination of mupirocin is primarily renal.
Dosage
Standard Dosage
Adults: Apply a small amount of ointment to the affected area three times daily for up to 10 days. The treated area can be covered with a gauze dressing, if needed. For nasal colonization of Staphylococcus aureus, apply half the contents of a single-use tube to each nostril twice daily (morning and evening) for 5 days.
Children:
-
Mupirocin Cream: Children 3 months and older: Apply three times daily for 10 days. Use in children younger than 3 months has not been established.
-
Mupirocin Ointment: Children 2 months and older: Apply a small amount to the affected area three times daily for up to 10 days. Use in children younger than 2 months has not been established. A doctor must determine the dose for nasal application in children under 12.
Special Cases:
- Elderly Patients: Generally, the same dosage as adults is used, but careful monitoring for side effects is essential.
- Patients with Renal Impairment: Exercise caution due to the presence of polyethylene glycol in some formulations. Monitor renal function.
- Patients with Hepatic Dysfunction: No specific dosage adjustments are typically needed due to minimal systemic absorption.
- Patients with Comorbid Conditions: Consult product-specific information for conditions like diabetes or cardiovascular disease, as specific bromelain interactions may exist.
Clinical Use Cases
The Bromelain + Mupirocin combination is primarily indicated for topical skin infections. It’s not typically used for intubation, surgical procedures, mechanical ventilation, ICU use, or emergency situations.
Dosage Adjustments
Adjustments may be necessary based on the infection severity, patient response, and emerging side effects. Modifications are crucial for patients with renal impairment.
Side Effects
Common Side Effects
- Burning or stinging at the application site
- Itching
- Dryness
- Redness
Rare but Serious Side Effects
- Severe allergic reactions (rash, swelling, difficulty breathing)
- Severe skin irritation or breakdown
Long-Term Effects
- Prolonged use may lead to the overgrowth of resistant organisms, including fungi.
Adverse Drug Reactions (ADR)
Contraindications
- Hypersensitivity to mupirocin, bromelain, or any component of the formulation.
- Open wounds or burns (for some formulations containing polyethylene glycol).
- Allergy
- Peptic ulcer
- Burns
- Kidney Disease
Drug Interactions
- Mupirocin: No clinically significant drug interactions have been definitively established.
- Bromelain: Potential interactions with anticoagulants, antiplatelet agents, and certain antibiotics. It may also interact with certain antibiotics, increasing their bioavailability. Alcohol and certain foods could theoretically affect bromelain activity. The combination may interact with medications metabolized by CYP450 enzymes.
Pregnancy and Breastfeeding
- Pregnancy: Limited data available. Mupirocin is generally considered safe during pregnancy. Bromelain should be used cautiously during pregnancy.
- Breastfeeding: Mupirocin and bromelain are excreted in breast milk. Exercise caution and wash the treated area thoroughly before breastfeeding.
Drug Profile Summary
(See above for more details).
Popular Combinations
This is not a typically combined formulation outside of the topical preparations specifically mentioned.
Precautions
(See above for more details).
FAQs (Frequently Asked Questions)
Q1: What is the recommended dosage for Bromelain + Mupirocin?
A: Apply a small amount to the affected area 3 times daily for up to 10 days. Adjust for children and specific formulations.
Q2: Can I use this on open wounds?
A: Not all formulations are suitable for open wounds. Consult the product information.
Q3: What are the common side effects?
A: Common side effects include burning, stinging, itching, dryness, and redness at the application site.
Q4: Are there any drug interactions I should be aware of?
A: Bromelain may interact with anticoagulants, antiplatelet agents, and certain antibiotics.
Q5: Can pregnant or breastfeeding women use this medication?
A: Use with caution. Consult a physician before use. Wash the treated area thoroughly before breastfeeding.
Q6: How does mupirocin work?
A: Mupirocin inhibits bacterial protein synthesis by binding to isoleucyl-tRNA synthetase.
Q7: How does bromelain work?
A: Bromelain is a proteolytic enzyme that breaks down proteins, reducing inflammation and promoting healing.
Q8: What should I do if a severe skin reaction occurs?
A: Discontinue use immediately and consult a physician.
Q9: How should I store Bromelain + Mupirocin?
A: Store at room temperature away from direct sunlight and moisture.
Q10: Is Bromelain + Mupirocin safe for use in children?
A: It is safe for use in children older than two to three months for the ointment and cream respectively, however, consult a physician before applying to children below these age groups.
