Thursday 2 September 2021

Utilization of Prophylactic Antibiotics After Nasal Packing for Epistaxis

When I trained, I was told I needed to prescribe prophylactic antibiotics after I placed nasal packing. It was thought this reduced the potential for toxic shock syndrome or sinusitis. Is this recommendation evidence based?


This single ED in Manhattan retrospectively reviewed 275 cases of anterior nasal packing and determined the rates of antibiotics given and evidence of benefit.

Most patients that got non-absorbable packs (Merocel, RapidRhino) got antibiotics. Those with absorbable packs (Surgicel, Gelfoam) did not.  Although this aspect of the study is robust, it is hardly important… I just don’t care.

I want to know how many patients got benefit from antibiotics.

Out of the 275 cases, there was one episode of sinusitis in each group. Looks like it doesn’t matter?

But there is a fatal flaw.

They didn’t really look for outcomes.

Only 40% of the patients had documented follow up! In addition, this would have been poor quality retrospective data.

If you don’t look for something, you will not find it. Interesting that this study got published.

Probably the best thing to come out of this “study” is their review of the literature.  In a nutshell, there is moderate evidence to show that antibiotics are not needed after nasal packing.

Good enough for me.



Hu L, Gordon SA, Swaminathan A, et al. Utilization of Prophylactic Antibiotics after Nasal Packing for Epistaxis. J Emerg Med. 2021;60:140-149. [link to article]


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