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

Quincy K. Tran, Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore, MD, United States; Research Associate Program in Emergency Medicine & Critical Care, Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore, MD, United States; Program In Trauma, The R Adam Cowley Shock Trauma Center, University of Maryland School of Medicine, Baltimore, MD, United States. Electronic address: qtran@som.umaryland.edu.
Isha Vashee, Research Associate Program in Emergency Medicine & Critical Care, Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore, MD, United States.
Rohan Vanga, Research Associate Program in Emergency Medicine & Critical Care, Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore, MD, United States.
Samantha Camp, University of Maryland School of Medicine, Baltimore, MD, United States. Electronic address: samantha.camp@som.umaryland.edu.
Mellisa K. Rallo, University of Maryland School of Medicine, Baltimore, MD, United States. Electronic address: mrallo@som.umaryland.edu.
Daniel Najafali, Carle Illinois College of Medicine, University of Illinois Urbana-Champaign, Urbana, IL, United States. Electronic address: danieln6@illinois.edu.
Laura J. Bontempo, Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore, MD, United States. Electronic address: lbontempo@som.umaryland.edu.
Ali Pourmand, Department of Emergency Medicine, George Washington University School of Medicine and Health Sciences, Washington, DC, United States. Electronic address: pourmand@gwu.edu.

Document Type

Journal Article

Publication Date

3-19-2025

Journal

The American journal of emergency medicine

Volume

93

DOI

10.1016/j.ajem.2025.03.040

Keywords

Anterior nasal packing; Clinically significant infection; Epistaxis; Prophylactic antibiotics

Abstract

INTRODUCTION: 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. METHODS: 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. RESULTS: 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). CONCLUSION: 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.

Department

Emergency Medicine

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