Is Antibiotic Prophylaxis Necessary for Anterior Epistaxis With Packing?
Authors: Quincy K Tran et al.
Journal: American Journal of Emergency Medicine, March 19, 2025
Conclusions
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Clinically significant infections are rare (<0.5%) regardless of antibiotic use.
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No reduction in infection risk with prophylactic antibiotics.
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Antibiotics carry potential for harm without clear benefit in this setting.
Clinical Takeaway
Routine prophylactic antibiotics are not necessary for patients receiving anterior nasal packing for spontaneous epistaxis in the ED.
This large study supports antibiotic stewardship and recommends against routine antibiotic use in this population.
Methods
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Data Source: TriNetX database (130 million patients).
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Study Design: Retrospective cohort with propensity score matching.
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Inclusion: Adults with spontaneous anterior epistaxis treated with ANP.
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Intervention: Prophylactic antibiotics within 1 day of ED visit.
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Primary Outcome: 30-day rate of CSI.
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Secondary Outcome: Adverse drug events (ADEs) within 30 days.
Results
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Sample Size: 6,302 patients
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Mean Age: 65 ± 19 years; 42% female
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Received Abx: 50% (n = 2737)
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CSI Rate:
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With Abx: 0.5% (15/2737)
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Without Abx: 0.4% (10/2750)
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Risk difference: 0.2%, not statistically significant (p = 0.31)
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ADE Rate:
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1% in both groups (26 per group), no significant difference (p = 0.94)
Tran, Q.K., Vashee, I., Vanga, R., Camp, S., Rallo, M., Najafali, D., Bontempo, L. and Pourmand, A., 2025. Is antibiotic prophylaxis necessary for anterior epistaxis with packing? Insights from a large database. The American Journal of Emergency Medicine.