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


METHODS
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.


CONCLUSIONS
We do not recommend the routine prescription of prophylactic antibiotics for patients undergoing nasal packing for spontaneous epistaxis.
ENT Department, St George's Hospital, London, UK. drpepper@doctors.org.uk
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D019980:Amoxicillin-Potassium Clavulanate Combination / Q000008:administration & dosage / Q000627:therapeutic use*; D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D019072:Antibiotic Prophylaxis; D004433:Earache / Q000453:epidemiology; D004844:Epistaxis / Q000628:therapy*; D006489:Hemostatic Techniques / Q000009:adverse effects; D006801:Humans; D009297:Nasal Mucosa; D017063:Outcome Assessment, Health Care; D010818:Practice Patterns, Physicians'; D011446:Prospective Studies; D012307:Risk Factors; D013630:Tampons, Surgical; D006113:United Kingdom
D000900:Anti-Bacterial Agents; D019980:Amoxicillin-Potassium Clavulanate Combination