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Should prophylactic antibiotics be used routinely in epistaxis patients with nasal packs?
T C Biggs1, K Nightingale, N N Patel
1University Hospital Southampton NHS Foundation Trust, UK. tim_biggs@ymail.com.
Insights
Systemic antibiotics are often unnecessary for epistaxis (nosebleed) patients with nasal packing. A new algorithm reduced their use by 58.2% without increasing infection or rebleeding risks.
Area of Science:
- Otolaryngology
- Infectious Disease
Background:
- Current practices for prophylactic antibiotic use in epistaxis patients with nasal packing are inconsistent.
- Lack of validated guidelines contributes to variable treatment approaches.
Purpose of the Study:
- To evaluate a new treatment algorithm aimed at reducing systemic antibiotic use in epistaxis patients.
- To compare outcomes before and after implementing guidelines emphasizing topical antibiotics.
Main Methods:
- A study involving 57 patients undergoing nasal packing for spontaneous epistaxis.
- Implementation of new guidelines and a subsequent reaudit.
- Telephone surveys at six weeks post-discharge to assess infective symptoms, rebleeding, and readmission.
Main Results:
- Systemic antibiotic prescribing decreased by 58.2% after guideline implementation.
- No statistically significant increase in infective nasal symptoms, rebleeding, or readmission rates was observed.
- The audit validated the effectiveness of the new treatment algorithm.
Conclusions:
- Systemic prophylactic antibiotics are generally not required for epistaxis patients with nasal packs.
- Topical antibiotics may be a more appropriate, cost-effective, and equally effective alternative.
- The new algorithm standardizes antibiotic use, potentially reducing healthcare costs.
Introduction:
The 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.
Methods:
A 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.
Results:
Systemic 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.
Conclusions:
Systemic 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.
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