Should prophylactic antibiotics be used routinely in epistaxis patients with nasal packs?

Abstract

IntroductionThe current mainstream practice in otolaryngology departments relating to the use of prophylactic antibiotics in epistaxis patients requiring nasal packing is highly variable. This is due primarily to the lack of any validated guidelines. As such, we introduced a new treatment algorithm resulting in significant reduction of use in the systemic antibiotics, with emphasis instead on the use of topical antibiotics. The results were validated through a complete audit cycle.MethodsA total of 57 patients undergoing nasal packing for spontaneous epistaxis were studied. Reaudit occurred after the implementation of new guidelines. Telephone surveys were conducted six weeks after hospital discharge, assessing infective nasal symptoms as well as rebleeding and readmission rates.ResultsSystemic antibiotic prescribing in anterior nasal packing fell by 58.2% between audit cycles with no statistically significant associated increase in infective nasal symptoms, rebleeding or readmission rates six weeks following hospital discharge.ConclusionsSystemic prophylactic antibiotics are unnecessary in the majority of epistaxis patients with nasal packs. The use of topical antibiotics such as Naseptin® may be more appropriate, cheaper and as effective. Implementation of this treatment algorithm will help standardise systemic antibiotic usage in epistaxis patients with nasal packing and should reduce costs associated with unnecessary use of such medication.

The role of antibiotics in endoscopic sinus surgery

“…Nasal culture results at the time of packing removal have been overall similar to those of nonpacking nasal cavities [40]. A recent study by Biggs et al [39] reviewed the use of antibiotics in patients with anterior nasal packs for epistaxis, showing that there were no difference in outcomes such as infective nasal symptoms, rebleeding, or readmission, even though antibiotic use fell 58% during the time period studied. These authors suggest that use of a topical antibiotic might be a more effective and cheaper alternative to oral antibiotics.…”

“…From 2009 to 2013, studies have failed to demonstrate improvement in outcomes or reduction in adverse events with routine use of oral antibiotics [39][40][41]. Nasal culture results at the time of packing removal have been overall similar to those of nonpacking nasal cavities [40].…”

Prophylactic Antibiotics Alone Versus Combined Prophylaxis and Postoperative Antibiotics for Preventing Surgical-Site Infections Associated With Ear and Nose Reconstructive Surgery

“…In this study, seven subjects with postoperative anterior packing underwent its removal 48 h later, so there was no need for a systemic antibiotic. The principle of preventing infection due to nasal packing is applicable not only to postoperative patients but also those with epistaxis [17].…”

Ear bolster button

“…Porous materials such as cotton are more prone to collect bacteria and are not as easily cleaned. Multiple studies throughout the years have shown that cotton‐based products (e.g., tampons and nasal packs) may lead to life‐threatening infections, including toxic shock syndrome due to the exotoxin from S taphylococcal aureus or simple skin infections. Cotton and other absorbable bolsters are able to soak up excess drainage, thus taking a longer time to dry, leading to skin maceration and breakdown.…”