A prospective, single-blind, randomized controlled trial of antiseptic cream for recurrent epistaxis in childhood

Abstract

Epistaxis is common in children. Trials show antiseptic cream is as effective as cautery, but it is not known whether either is better than no treatment. We wished to know the efficacy of cream in children with recurrent epistaxis. The design was a single-blind, prospective, randomized controlled trial set in the Otolaryngology clinic in a children's hospital. The participants were 103 children referred by their general practitioner for recurrent epistaxis. Excluded were those with suspected tumours, bleeding disorders or allergies to constituents of the cream. Referral letters were randomized to treatment and no treatment groups. Treatment was antiseptic cream to the nose twice daily for 4 weeks, which was prescribed by the general practitioner before clinic attendance. All children were given an appointment for 8 weeks after randomization. The main outcome measures were the proportion of children in each group with no epistaxis in the 4 weeks preceding clinic review. Complete data were available for 88 (85%) of the children. Of the treatment group, 26/47 (55%) had no epistaxis in the 4 weeks before the clinic appointment. Of the controls, 12/41 (29%) had no epistaxis over the 4 weeks. This is a relative risk reduction of 47% for persistent bleeding (95% CI 9-69%) and an absolute risk reduction of 26% (95% CI 12-40%), giving a number needed to treat of 3.8 (95% CI 2.5-8.5). We conclude that antiseptic cream is an effective treatment for recurrent epistaxis in children.

Management of pediatric epistaxis in different age group in a tertiary care centre

“…1,12 Topical antiseptic cream does appear to assist in reducing the frequency of nosebleeds in clinical practice, and a randomised control trial of 103 children demonstrated that 4 weeks treatment with 0.5% neomycin+0.1% chlorhexidine cream (naseptin) is effective (relative risk reduction 47%, absolute risk reduction 26%, number needed to treat 3.8), although not statistically significant, according to recent a Cochrane review. 18 In present study 61% of traumatic patients managed with observation alone whereas 55.8% of inflammatory group and 66.7% of blood dyscrasia group needed nasal packing for control of epistaxis. In children with epistaxis secondary to underlying haematological coagulopathies, the primary focus is on correcting underlying clotting problems where possible, and/or the use of topical haemostatic agents.…”

Epistaxis in healthy children requiring hospital admission

“…Previous studies have reported on children with recurrent minor epistaxes [4][5][6] but our study appears to be the first to examine the outcomes of children with acute severe epistaxis requiring hospital admission. The data suggests that epistaxis requiring hospital admission is uncommon in healthy children, with only 14 admissions over a 10-year-period to a major pediatric center, and that the incidence of underlying serious pathology is low.…”

Epidemiology of Epistaxis in US Emergency Departments, 1992 to 2001

“…6 Moreover, epistaxis can be treated by compression and oxymetazoline alone in 65% of cases, implying that many ED visits for epistaxis could be preventable. 7 Knowledge of the frequency of ED epistaxis visits, mode of arrival, and disposition is a prerequisite to determining the utility of preventive efforts.…”