Rhinologist Use of Antibiotics With Nasal Packing for Epistaxis

Abstract

Background There is limited evidence supporting the usage of prophylactic antibiotics in the setting of nasal packing for epistaxis. It is unclear what current antiobiotic usage patterns are by otolaryngologists. Objectives Characterize the antibiotic prescribing practices employed by otolaryngologists in the management of epistaxis patients treated with packing as well as the underlying rationale. Explore the impact of experience, geography, and academic affiliation on treatment decisions. Methods An anonymous survey of antibiotic prescribing patterns for patients with epistaxis requiring nasal packing was distributed to all physician members of the American Rhinologic Society. Responses to each question were descriptively summarized including 95% confidence intervals and were linked to demographics using Fisher's exact tests. Results One thousand one hundred and thirteen surveys were distributed with 307 responses (27.6%). Antibiotic prescription rates varied based on packing type, with 20.0% prescribing antibiotics for dissolvable packing compared to 84.2% to 84.6% for nondissolvable packing. The absorbance of nondissolvable packing does not impact the decision to prescribe antibiotics ( P > .999). Precisely 69.7% (95% CI: 64.0%-74.8%) stop antibiotics immediately following packing removal. Precisely 85.6% (95% CI: 81.6%-89.9%) cite the risk of toxic shock syndrome (TSS) when prescribing antibiotics. Notable regional differences include greater utilization of amoxicillin-clavulanate in the Midwest (67.6%) and Northeast (61.4%) as compared with the South (42.1%) and West (45.1%) ( P = .013). Further, years in practice were positively associated with several patterns including prescribing antibiotics for patients with dissolvable packing ( P = .008), citing prevention of sinusitis as a rationale for antibiotic use ( P < .001), and a higher likelihood of having treated a patient with TSS ( P = .002). Conclusions Antibiotic use in patients with epistaxis controlled with nondissolvable packing is common. Treatment patterns are influenced by geography, years in practice, and practice type. Level of Evidence 4.

Bringing Together Multiple Perspectives in Rhinology and Allergy

“…In this issue, Mallen et al surveyed otolaryngologists to evaluate clinical management patterns and identified antibiotic use most frequently with nondissolvable packing, commonly due to the risk of toxic shock syndrome, and most stop following packing removal. 9…”

“…In this issue, Mallen et al surveyed otolaryngologists to evaluate clinical management patterns and identified antibiotic use most frequently with nondissolvable packing, commonly due to the risk of toxic shock syndrome, and most stop following packing removal. 9 From a clinical perspective, meta-analyses are particularly valuable in delivery of evidence-based medical care. In this issue, El-Adem et al systematically reviewed the role of positron emission tomography (PET) scans in evaluation of sinonasal malignancies, to find PET scans are particularly useful for detection of distant metastases, with the exception of sinonasal lymphoma.…”