Is antibiotic prophylaxis necessary for anterior epistaxis with packing? Insights from a large database

Patients with spontaneous epistaxis frequently receive anterior nasal packing (ANP) when bleeding is not controlled by other measures in the emergency department (ED). Many patients also receive prophylactic antibiotics (Abx), although the evidence about their benefits mostly derived from small studies, is unclear. This study aimed to leverage a large international database to investigate the prevalence of clinically significant infection (CSI) among patients with ANP who received prophylactic Abx.

This is a retrospective analysis from TriNetX which includes 130 million patients. All adult patients who underwent ANP for spontaneous epistaxis were eligible. The intervention was prophylactic Abx within one day of the index ED visits; outcomes were 30-day rate of CSI, and adverse drug events (ADE). We utilized TriNetX's propensity score matching using demographic and clinical variables to match patients prior to comparing their outcomes.

6302 patients were eligible for analysis, mean age (±SD) for both groups was 65 (±19 years), 42 % being female. The CSI analysis included 5487 patients, 2737 (50 %) receiving Abx. Total rate of CSI was 25 (0.45 %) patients, 15 (0.5 %) among patients with prophylactic Abx compared with 10 (0.4 %) CSI for those without Abx (Risk Difference 0.2 %, 95 % CI -0.005 to 0.002, p = 0.31). There were 26 (1 %) patients with ADE per group (Risk Difference 0, 95 % CI -0.005 to 0.006, p = 0.94).

The results from this large group of patients demonstrated that the rates of CSI and ADE among patients with anterior nasal packing for spontaneous epistaxis were low. We recommend against the practice of prophylactic antibiotics in anterior nasal packing, since the practice provides little benefit while posing a potential risk to the population.