Augmentin is NOT indicated for epistaxis
Augmentin (amoxicillin-clavulanate) has no role in the routine management of epistaxis, as nosebleeds are not caused by bacterial infection and prophylactic antibiotics are not indicated even when nasal packing is used. 1, 2
Why Antibiotics Are Not Indicated
Epistaxis is a mechanical bleeding problem, not an infectious condition. The management focuses on hemostasis through:
- First-line measures: Bidigital compression, clearing blood clots, and local vasoconstrictors (oxymetazoline) 3
- Procedural interventions: Cauterization, nasal packing, or endoscopic techniques when first-line measures fail 4, 3
- Advanced interventions: Arterial ligation or embolization for refractory cases 4
Evidence Against Prophylactic Antibiotics with Nasal Packing
Even when anterior nasal packing is placed—a scenario where some clinicians historically prescribed antibiotics—the evidence clearly demonstrates no benefit:
- No documented infections occurred in patients with anterior nasal packing regardless of antibiotic use in a 5-year retrospective study of 106 patients 1
- Bacterial growth patterns were identical between packed and non-packed sides of the nose in a prospective study, with no clinical infections observed 2
- Current practice is inconsistent: Only 53.7% of emergency physicians prescribed prophylactic antibiotics for nasal packing, yet infection rates remained zero in both groups 1
Common Pitfall to Avoid
Do not confuse epistaxis with acute bacterial rhinosinusitis (ABRS). While Augmentin is appropriate for ABRS with risk factors for resistant organisms 5, epistaxis itself—even when associated with nasal inflammation or trauma—does not warrant antibiotic therapy 4, 3, 6.
The only scenario where antibiotics might be considered is if a patient develops secondary bacterial sinusitis as a complication, which would then be treated according to sinusitis guidelines, not epistaxis protocols 5.