Prophylactic antibiotics for immunosuppressed individuals with anterior nasal packing: A propensity score matched analysis

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.
Melissa K. Rallo, University of Maryland School of Medicine, Baltimore, MD, United States. Electronic address: mrallo@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.
Daniel Najafali, Carle Illinois College of Medicine, University of Illinois Urbana-Champaign, Urbana, IL, United States. Electronic address: danieln6@illinois.edu.
Claudia Wong, University of Maryland School of Medicine, Baltimore, MD, United States. Electronic address: claudia.wong@som.umaryland.edu.
Justin Bai, Research Associate Program in Emergency Medicine & Critical Care, Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore, MD, United States. Electronic address: jbai16@jhu.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

11-2-2025

Journal

The American journal of emergency medicine

Volume

99

DOI

10.1016/j.ajem.2025.10.065

Keywords

Anterior packing; Epistaxis; Immunosuppressed; Prophylactic antibiotics

Abstract

INTRODUCTION: Patients presenting to an emergency department (ED) with anterior epistaxis may undergo anterior nasal packing (ANP) to achieve hemostasis. Most prior studies suggested that prophylactic antibiotics are not necessary for the general population, but this practice is still controversial among immunosuppressed patients. This study, which analyzes a large database to assess clinically significant infection (CSI) and adverse drug reaction rates in immunosuppressed ANP patients with and without prophylactic antibiotics, hypothesized that prophylactic antibiotics also are not beneficial for this vulnerable population. METHODS: The TriNetX Global Research Network database, which contains up to 130 million patients, was used to include adult patients if they had ANP and immunosuppressed status. Cohorts were then identified based on antibiotic administration within one day after the index Emergency Department visit. These cohorts were propensity-matched based on clinical and demographic data, and then rates of CSIs and adverse drug reactions were analyzed using the TriNetX platform. RESULTS: After propensity score matching, 2236 individuals were identified with 1118 patients per cohort. The mean age of each group was 69 (±19) years with females accounting for 42 % of the control group and 41 % of the intervention group. Seventy-two patients (6.4 %) in the control group and 83 patients (7.4 %) in the intervention group had CSIs within 30 days of the index event (Risk Difference [RD] -0.01, 95 % CI -0.031 to 0.011, P = 0.25). The number needed to treat (NNT) based on these results is 100. Rates of adverse drug reactions in the control (220 patients, 19.7 %) were also similar to the intervention groups (247 patients, 22.1 %, RD -0.024, 95 % CI -0.058 to 0.01, P = 0.10). CONCLUSION: Results from this large database study of immunosuppressed individuals with ANP after epistaxis demonstrate similar rates of CSIs between cohorts who did and did not receive prophylactic antibiotics. Although adverse drug event rates were also similar, they exceeded CSI rates. Clinicians should consider these findings, the rates of adverse drug reactions, and concern for antibiotic stewardship when evaluating the need for prophylactic antibiotics in this immunosuppressed population.

Department

Emergency Medicine

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