From the Guidelines
For a patient with a nasal pack for epistaxis, a 5-day course of Augmentin (amoxicillin-clavulanate) is typically recommended, as the packing should generally not remain in place for more than 5 days to minimize infection risk 1.
Key Considerations
- The duration of antibiotic prophylaxis should align with the recommended duration of nasal packing, which is typically no longer than 5 days 1.
- The standard adult dosage of Augmentin is 875 mg amoxicillin/125 mg clavulanate twice daily, or 500 mg amoxicillin/125 mg clavulanate three times daily.
- Antibiotic prophylaxis is given to prevent toxic shock syndrome and other infectious complications while the nasal packing remains in place.
- It's essential to weigh the benefits and risks of antibiotic use, considering the potential for allergic reactions and gastrointestinal problems 1.
Important Reminders
- Patients should avoid straining, lifting over 10 pounds, bending over, and exercising to minimize the risk of further bleeding.
- Sleeping with the head slightly elevated may also help reduce bleeding risk.
- Patients should not try to blow their nose if they have packing in place and should sneeze with their mouth open if necessary.
- Any concerning symptoms, such as return of blood from the nose or mouth, fever over 101°F, or increasing pain, should be reported to the clinician promptly 1.
From the Research
Nasal Packing and Antibiotic Use for Epistaxis
- The use of prophylactic antibiotics with nasal packing for epistaxis has been a topic of debate, with varying practices among healthcare professionals 2, 3, 4.
- Studies have shown that the rate of infection in patients with nasal packing for epistaxis is low, suggesting that prophylactic antibiotics may not be necessary 2, 3, 5.
- A systematic review and meta-analysis found that the proportion of clinically significant infections in patients with anterior nasal packing was 0.8%, resulting in a number needed to treat of 571 to prevent one infection 3.
- A survey of otolaryngologists found that antibiotic prescription rates varied based on packing type, with 20.0% prescribing antibiotics for dissolvable packing and 84.2-84.6% for nondissolvable packing 4.
- The same survey found that 69.7% of respondents stopped antibiotics immediately following packing removal, and 85.6% cited the risk of toxic shock syndrome as a reason for prescribing antibiotics 4.
Duration of Antibiotic Use
- There is limited evidence to support the use of prophylactic antibiotics for a specific duration in patients with nasal packing for epistaxis.
- One study found that 69.7% of otolaryngologists stopped antibiotics immediately following packing removal, suggesting that a short course of antibiotics may be sufficient 4.
- However, the optimal duration of antibiotic use in this setting is unclear, and further studies are needed to determine the most effective and safe approach 2, 3, 5.