Randomized controlled trial of topical mupirocin versus mupirocin with sucralfate combination in chronic skin ulcers

Abstract

OBJECTIVES:The objective of this study was to carry out a head-to-head comparison of topical sucralfate combined with mupirocin versus mupirocin alone in the treatment of chronic skin ulcers with respect to both effectiveness and safety.MATERIALS AND METHODS:A parallel-group, open-label, randomized, controlled trial (CTRI/2015/12/006443) was carried out with patients suffering from skin ulcers of Wagner grading 1 or 2 persisting for over 4 weeks. Ninety-six patients were recruited in total, and the modified intention-to-treat analysis dataset included 44 participants treated with mupirocin 2% and 46 treated with combined mupirocin 2% and sucralfate 7% ointment. Both medications were applied topically thrice daily for 6 weeks. Ulcer area assessed using millimeter graph paper and wound infection score assessed on a three-point scale were effectiveness measures. Treatment-emergent adverse reactions that were reported by patients or observed by the investigators were recorded.RESULTS:The median ulcer area was significantly reduced in the combined treatment group at the end of treatment. Clinically, 41.3% of the participants in the combined group showed complete ulcer healing at 6 weeks compared to 18.18% in the mupirocin alone group (P = 0.022). The wound infection score declined significantly from baseline by the end of 3 weeks of treatment in both the groups. The frequency of qualitative wound attributes, namely pain, discharge, and erythema, remained comparable between the groups except for discharge which disappeared completely from all remaining ulcers in the combined group but was still present in 11.36% of the participants treated with mupirocin alone (P = 0.025) at 6 weeks. Adverse events were few, all local, mild, and tolerable.CONCLUSIONS:The wound healing effect of topical sucralfate adds to the antimicrobial effect of mupirocin toward the overall improvement of chronic skin ulcers. The effect of combined topical treatment needs comparison with other topical medications and wound healing strategies.

Sucralfate enemas reduce the oxidative tissue damage and preserves the contents of E-cadherin and ?-catenin in colonic mucosa without fecal stream

“…SCF is employed in the treatment of different gastrointestinal diseases to reduce inflammation of the epithelial surface and favor the healing process 18 . SCF join tightly to the inflamed mucosa, forming a stable and insoluble layer that protect damaged epithelium 20,21 . SCF improves the healing of inflamed mucosa, has an antioxidant and anti-inflammatory properties, and stimulates the production of EGF [18][19][20][21][22][23][24] .…”

“…SCF join tightly to the inflamed mucosa, forming a stable and insoluble layer that protect damaged epithelium 20,21 . SCF improves the healing of inflamed mucosa, has an antioxidant and anti-inflammatory properties, and stimulates the production of EGF [18][19][20][21][22][23][24] . Authors who evaluated the effects of SCF using models of chemically-induced colitis have shown that the application of clysters with SCF increases mucosal repair, probably through increasing mucus production, which favors epithelial healing 31,32 .…”

“…Due to all these features, SCF has been used for several years to heal different types of cutaneous lesions, such as surgical wounds and those caused by skin ulcers, mucositis, and mucosal ulceration of the gastrointestinal tract [18][19][20][21][22] . Enemas with SCF have also been considered a promising tool for the treatment of different types of colitis 14,[23][24][25] .…”

Recent Advances in Mupirocin Delivery Strategies for the Treatment of Bacterial Skin and Soft Tissue Infection

“…It was found that the antibacterial efficacy of MUP was enhanced by combing with topical sucralfate in contrast to MUP alone. The results revealed that the skin ulcer area was reduced significantly in the combination treatment [92]. In another study, antimicrobial activity against S. aureus, MUP alone, or both in combination with any of monoterpenes, such as thymol, menthol, and 1,8-cineole, was tested.…”

Efeitos da aplicação de clisteres com sucralfato no conteúdo das proteínas e-caderina e 'beta'-catenina na mucosa cólica desprovida de trânsito intestinal

“…O SCF vem sendo empregado há décadas no tratamento de diferentes doenças gastrointestinais com o objetivo de reduzir a inflamação da superfície epitelial e favorecer o processo de cicatrização 73 . O SCF, possui uma alta capacidade adesiva juntando-se firmemente às erosões da mucosa inflamada, formando uma camada estável e insolúvel que recobre o epitélio danificado 74,75 . O SCF melhora a cicatrização da mucosa inflamada por estimular a produção do fator de crescimento epitelial, aumenta a redução de muco pelas células do epitélio do trato gastrointestinal, além de apresentar…”