Alternatives to Bactroban If You Can't Fill Your Prescription

Bactroban (mupirocin) is the first-line topical antibiotic for impetigo and common bacterial skin infections in the United States. But there are situations where patients and providers need to consider alternatives — whether due to a local stockout, an allergic reaction to mupirocin, confirmed mupirocin resistance, or insurance coverage issues.

This guide covers the best FDA-approved and clinically recommended alternatives to Bactroban, with notes on when each one is appropriate.

Why Might You Need an Alternative to Bactroban?

Your pharmacy (or nearby pharmacies) are temporarily out of Bactroban or generic mupirocin

A culture confirmed mupirocin-resistant bacteria (especially high-level MupA resistance in MRSA)

You or your child has an allergy to mupirocin or polyethylene glycol (PEG), the ointment base

The infection is too widespread or extensive for topical therapy alone

Cost or insurance coverage makes Bactroban inaccessible

Option 1: Retapamulin (Altabax) — Closest Prescription Topical Alternative

Retapamulin (brand name Altabax) is an FDA-approved topical antibiotic in the pleuromutilin class. It's the closest direct alternative to Bactroban for treating impetigo.

Dosing advantage: Applied only twice daily for 5 days (vs. Bactroban's 3 times daily for up to 10 days)

Approved for: Impetigo due to methicillin-susceptible S. aureus (MSSA) and S. pyogenes in patients 9 months and older

Limitation: NOT approved or effective against MRSA; treatment area limited to 100 cm² in adults or 2% of body surface area in children

Cost: More expensive than generic mupirocin; a generic retapamulin is available and more affordable than brand Altabax

Option 2: Ozenoxacin (Xepi) — Newer Topical Option

Ozenoxacin 1% cream (brand name Xepi) is a newer FDA-approved non-fluorinated quinolone topical antibiotic for impetigo. It's applied twice daily for 5 days.

Best for: Patients with mupirocin resistance or failure, ages 2 months and older

Availability: Not stocked at all pharmacies — may need to be special-ordered

Option 3: Oral Cephalexin (Keflex) — For Extensive or Widespread Infection

For impetigo that is widespread (more than just a few isolated patches), oral antibiotics are preferred. Cephalexin (a first-generation cephalosporin) is the most commonly used oral antibiotic for impetigo and community-acquired staph skin infections in the U.S.

Dosing: Typically 250–500 mg 4 times daily for 7–10 days in adults; weight-based dosing for children

Clinical evidence: Clinical trials have shown similar cure rates between topical mupirocin and oral cephalexin for limited impetigo

Option 4: Oral Clindamycin — When MRSA Is Suspected

If community-acquired MRSA (CA-MRSA) is suspected — especially in skin infections that haven't responded to mupirocin — oral clindamycin is a commonly used option. Your provider should check local antibiogram data for clindamycin resistance rates in your area before prescribing.

What About OTC Options Like Neosporin or Bacitracin?

Over-the-counter antibiotic ointments like Neosporin (neomycin/polymyxin B/bacitracin) or plain bacitracin are significantly less effective than mupirocin for treating impetigo. Clinical evidence shows bacitracin is inferior to mupirocin, and Neosporin's neomycin component is a common allergen. These products are not recommended as substitutes for Bactroban in treating active impetigo or skin infections.

Talk to Your Prescriber Before Switching

Always consult your prescriber before switching from Bactroban to an alternative. The right choice depends on the type of bacteria causing your infection, the severity, and your medical history. If you're still trying to locate Bactroban first, read our guide on why Bactroban is hard to find and how to track it down quickly.