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Prospective study of the risk of not using prophylactic antibiotics in nasal packing for epistaxis

  • C Pepper (a1), S Lo (a1) and A Toma (a1)

Abstract

Background:

There is wide variation in UK prescribing practice regarding prophylactic antibiotics for nasal packing in spontaneous epistaxis. There are few published cases of infective complications in such patients.

Method:

This prospective study examined 149 consecutive patients admitted to a tertiary otorhinolaryngology centre with spontaneous epistaxis, who underwent nasal packing, over a six-month period. In the first three-month period, 78 patients were routinely prescribed prophylactic antibiotics; in the second three months, 71 patients were not routinely prescribed antibiotics. Exclusion criteria included antibiotics prescribed for unrelated pathology and post-operative epistaxis. Signs and symptoms of acute otitis media, sinusitis and toxic shock syndrome were assessed using clinical examination and a questionnaire.

Results:

Fourteen of the 149 patients experienced otalgia, most commonly following posterior nasal packing. No patient in either group had evidence of any infective complication.

Conclusion:

We do not recommend the routine prescription of prophylactic antibiotics for patients undergoing nasal packing for spontaneous epistaxis.

Copyright

Corresponding author

Address for correspondence: Mr C Pepper, ENT Department, Frimley Park Hospital, Portsmouth Rd, Frimley GU16 7UJ, UK E-mail: drpepper@doctors.org.uk

Footnotes

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Presented at the South West ENT Academic Meeting (SWEAM), 19 June 2009, Bath, UK

Footnotes

References

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1Biswas, D, Wilson, H, Mal, R. Use of systemic antibiotics with anterior nasal packing in England, UK. Clin Otolaryngol 2006;31:566–7
2Thompson, AC, Crowther, JA. Effect of nasal packing on Eustachian tube function. J Laryngol Otol 1991;105:539–40
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4Daudia, A, Jaiswal, V, Jones, NS. Guidelines for the management of idiopathic epistaxis in adults: how we do it. Clin Otolaryngol 2008;33:618–20
5Browning, GG. Clinical Otology and Audiology, 2nd edn.Oxford: Butterworth Heinmann, 1998
6McCurdy, JA. Effects of nasal packing on Eustachian tube function. Arch Otolaryngol 1977;103:521–3
7Nahass, RG, Gocke, DJ. Toxic shock syndrome associated with use of nasal tampon. Am J Med 1988;84:629–31
8Ogawa, TK, Bergeron, RT, Whitaker, CW, Miles, JW, Rumbaugh, CL. Air-fluid levels in the sphenoid sinus in epistaxis and nasal packing. Radiology 1976;118:351–4
9Orlandi, RR, Lanza, DC. Is nasal packing necessary following endoscopic sinus surgery? Laryngoscope 2004;114:1541–4
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The Journal of Laryngology & Otology
  • ISSN: 0022-2151
  • EISSN: 1748-5460
  • URL: /core/journals/journal-of-laryngology-and-otology
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