Antibiotics for Nasal Packing?

December 14, 2020

Written by Clay Smith

Spoon Feed
There was no evidence of benefit from prophylactic antibiotics for ED patients with epistaxis and nasal packing.

Why does this matter?
After nasal packing for epistaxis, antibiotics are commonly prescribed to reduce the chance of bacterial toxin production and toxic shock syndrome. Prior meta-analyses have shown no benefit, but little is known about the ED context. This is one of the larger cohorts considering this. Is there any evidence that such prophylactic prescribing helps? We know excessive antibiotic use may cause harm and increase resistance.

Who knew so much could fit into a nose?
This was a single center retrospective study with 275 episodes of epistaxis (224 unique patients) who had anterior nasal packing. Of these, 125 had non-absorbable packing, and 73% received prophylactic antibiotics. There was one case of sinusitis in the antibiotic cohort, and no other infectious complications in either group. There were 150 patients with absorbable packing, 95% of whom did not receive antibiotics. There was one case of sinusitis in the non-antibiotic cohort, and no other infections in either group. Taking the entire group of 275 patients, there was no statistical difference in infection rate in patients who received or did not receive antibiotics. No patients developed toxic shock syndrome. There was no evidence of harm from antibiotics, although this may not have been captured by this retrospective design.

Source
Utilization of Prophylactic Antibiotics After Nasal Packing for Epistaxis. J Emerg Med. 2020 Nov 6;S0736-4679(20)31055-6. doi: 10.1016/j.jemermed.2020.10.011. Online ahead of print.

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