are antibiotics really helpful in nasal packing after epistaxis?

STUDY #1: questionnaire to UK docs asking about their clinical practice with nasal packing

--preferred nasal packing materials: merocel (72%), rapid rhino (17%), either merocel or rapid rhino (5%), BIPP pack (3%) and no preference (3%).

--antibiotics used if: packing in >24 hrs (37%), packing >48 hrs (28%), NOT used routinely (22%), for all packing (5%), no preference (8%)

--length of antibiotic course: while the pack was in (37%), 5 days (43%), 7 days (14%), no preference (6%)

--antibiotic choice: amoxycillin/clavulanic acid (73%), amoxycillin alone (17%), cephalosporin (10%)

--tangents: 78% of the interviewees believed prophylactic antibiotics reduce the incidence of infection (toxic shock syndrome – TSS, sinonasal infection and middle ear infection). Physicians (6%) suggested prophylactic antibiotics may help to reduce incidence of re-bleeding. The remainder (16%) stated they were unsure of the benefit of antibiotic use.


STUDY #2: small prospective pilot study in the UK looking at how antibiotics affected infection rates. 

--21 patients admitted over a six month period for unilateral anterior nasal packing for epistaxis.  Augmentin was started per hospital protocol if the packing remained in for greater than 24 hours.  After the packing was removed, nasal swabs were taken of both nares and cultured.  

--All 21 patients have the same microbiological growth patterns in the packed and non-packed sides of the nasal cavities.  Only 9 of those patients received antibiotics.  So the antibiotics don’t seem to affect bacteria growth.  Also, there were no clinical signs of infections.


10-SECOND TAKEAWAY:
--nasal packing perceived to increase infection risk (similar to tampon w/toxic shock)
--antibiotics tend to be prescribed, but no dramatic consensus on when to use or for how long
--small study suggests the antibiotics don't change nasal flora
--toxic shock would suck (incidence in post-op packing is 16 per 100,000 packing), but not much evidence prophylactic antibiotics do much to change that. need more data, but judge accordingly.


Submitted by J. Gullo.


Reference(s): study 1, study 2, uptodate.com: Approach to the adult with epistaxis, picture