View source for Staphylococcus aureus decolonization

* [[Staphylococcus aureus]] is commonly found in the nares and on the skin of healthy people
* Asymptomatic colonization is associated with a higher rate of invasive infection

== Project CLEAR ==

* Probably has the best evidence, with an RCT[[CiteRef::huang2019de]]
* Decolonization happens for 5 days, twice monthly, for 6 months
** 4% rinse-off chlorhexidine for daily bathing or showering
** 0.12% chlorhexidine mouthwash twice daily
** 2% nasal mupirocin twice daily
* NNT of about 30 to prevent one infection or one hospitalization

== Dutch Method ==

* Also has some evidence, with an observational study[[CiteRef::ammerlaan2011er]]
* Separates patients into uncomplicated (essentially entirely asymptomatic carriage in a low-risk patient) and complicated
* In the above report, the only reported outcome was decolonization
** 63% after 1 cycle, and 80% after up to 5 cycles of treatment
** 97% remained decolonized at 3 month follow-up

=== Uncomplicated carriage ===

* Topical treatment (5 days)
** Mupirocin 2% to nares q8h
** Chlorhexidine or povidone iodide soap applied once daily
* Hygienic measures
** Clean underwear, clothing, washcloths and towels daily
** Change bedsheets every other day during treatment

=== Complicated carriage ===

* As above, plus oral antibiotics
* [[Trimethoprim]] 200 mg PO BID or [[doxycycline]] 200 mg PO once daily, plus [[rifampin]] 600 mg twice a day for 1 week
* Alternative: [[clindamycin]] 600 mg PO TID or [[clarithromycin]] 500 mg PO BID or [[ciprofloxacin]] 750 mg PO BID or [[fusidic acid]] 500 mg PO TID, plus [[fusidic acid]] 500 mg PO TID

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