When is Antibiotic Prophylaxis for Nasal Packing Indicated?

Hong, Michelle K.; Beswick, Daniel M.; Wang, Marilene B.

doi:10.1002/lary.30159

Cited by 2 publications

(3 citation statements)

References 5 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The incidence of TSS, however, is exceedingly low and the benefit of routine use of prophylactic antibiotics with nasal packing for epistaxis is increasingly disputed with recent reviews even recommending against their usage. 7 Despite a reported incidence of TSS after sinus surgery of 0.0165% and only 2 published reports of TSS in the setting of nasal packing for epistaxis, 19.2% of respondents to this survey indicated experience in the care of a patient with TSS. This disparity is substantial even considering that multiple otolaryngologists may have participated in the care of a single patient with TSS.…”

Section: Discussionmentioning

confidence: 77%

“…6 Additionally, a recent review of the literature concluded that data published to date is underpowered to answer the question of efficacy of prophylactic antibiotic usage given the rarity of its occurrence, but did venture to recommend against its regular usage. 7 This recommendation was largely based on a recent study that concluded that antibiotic prophylaxis was not cost-effective when considering the infrequency of infectious complications with nasal packing. 8 To date, no studies have characterized the specific practice patterns of otolaryngologists treating epistaxis patients with packing.…”

Section: Introductionmentioning

confidence: 99%

“…The AAO Clinical Practice Guidelines on Epistaxis released in January 2020 consider the use of antibiotics in these patients “controversial.” The guidelines further state that “Given this lack of convincing data, the risks and benefits of antibiotic use in patients with packing in place should be evaluated in each patient.” 6 Additionally, a recent review of the literature concluded that data published to date is underpowered to answer the question of efficacy of prophylactic antibiotic usage given the rarity of its occurrence, but did venture to recommend against its regular usage. 7 This recommendation was largely based on a recent study that concluded that antibiotic prophylaxis was not cost-effective when considering the infrequency of infectious complications with nasal packing. 8…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Rhinologist Use of Antibiotics With Nasal Packing for Epistaxis

Mallen

Aasen

Vuncannon

et al. 2023

Am J Rhinol�Allergy

View full text Add to dashboard Cite

Background There is limited evidence supporting the usage of prophylactic antibiotics in the setting of nasal packing for epistaxis. It is unclear what current antiobiotic usage patterns are by otolaryngologists. Objectives Characterize the antibiotic prescribing practices employed by otolaryngologists in the management of epistaxis patients treated with packing as well as the underlying rationale. Explore the impact of experience, geography, and academic affiliation on treatment decisions. Methods An anonymous survey of antibiotic prescribing patterns for patients with epistaxis requiring nasal packing was distributed to all physician members of the American Rhinologic Society. Responses to each question were descriptively summarized including 95% confidence intervals and were linked to demographics using Fisher's exact tests. Results One thousand one hundred and thirteen surveys were distributed with 307 responses (27.6%). Antibiotic prescription rates varied based on packing type, with 20.0% prescribing antibiotics for dissolvable packing compared to 84.2% to 84.6% for nondissolvable packing. The absorbance of nondissolvable packing does not impact the decision to prescribe antibiotics ( P > .999). Precisely 69.7% (95% CI: 64.0%-74.8%) stop antibiotics immediately following packing removal. Precisely 85.6% (95% CI: 81.6%-89.9%) cite the risk of toxic shock syndrome (TSS) when prescribing antibiotics. Notable regional differences include greater utilization of amoxicillin-clavulanate in the Midwest (67.6%) and Northeast (61.4%) as compared with the South (42.1%) and West (45.1%) ( P = .013). Further, years in practice were positively associated with several patterns including prescribing antibiotics for patients with dissolvable packing ( P = .008), citing prevention of sinusitis as a rationale for antibiotic use ( P < .001), and a higher likelihood of having treated a patient with TSS ( P = .002). Conclusions Antibiotic use in patients with epistaxis controlled with nondissolvable packing is common. Treatment patterns are influenced by geography, years in practice, and practice type. Level of Evidence 4.

show abstract

Section: Discussionmentioning

confidence: 77%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Rhinologist Use of Antibiotics With Nasal Packing for Epistaxis

Mallen

Aasen

Vuncannon

et al. 2023

Am J Rhinol�Allergy

View full text Add to dashboard Cite

show abstract

Enhanced recovery after endoscopic sinus surgery: Establishing comprehensive protocols for improvement of perioperative patient care

Barrette,

Cohen,

Chao

et al. 2024

World j. otorhinolaryngol.-head neck surg.

View full text Add to dashboard Cite

ObjectivesEnhanced recovery after surgery (ERAS) protocols for endoscopic sinus surgery (ESS) have not been widely implemented, and a critical review of ERAS recommendations and a comprehensive analysis of the supporting literature has not been undertaken. We describe an ESS ERAS protocol including key perioperative interventions for patients undergoing ESS and assess the available evidence.Data SourcesA search was conducted of all relevant ERAS literature in otorhinolaryngology, anesthesia, and surgery using Medline (via PubMed), and Scopus. Keywords included “endoscopic sinus surgery,” “sinus surgery,” “FESS,” and “ESS” for each area of intervention. Where applicable, the authors considered high‐level evidence for recommendations devised for patient cohorts in otorhinolaryngology not undergoing ESS, as well as cohorts undergoing surgical procedures for which ERAS protocols have been extensively evaluated.MethodsStudies received grades of “low,” “moderate,” or “high” quality evidence based on the Oxford Centre for Evidence‐Based Medicine criteria. Each intervention was subsequently assigned a grade of “strong,” “weak,” or “conditional” based on the available evidence.ResultsStrong recommendations include comprehensive patient education and counseling, minimization of preoperative fasting, application of topical/local anesthetics and vasoconstrictors, use of total intravenous anesthesia, avoidance of pharyngeal packing, and use of postoperative nasal irrigation and multimodal analgesia. Conditional recommendations include antibiotic prophylaxis. Weak recommendations include perioperative venous thromboembolism prophylaxis, controlled hypotension, and use of postoperative nasal packing/dressing.ConclusionA comprehensive ERAS protocol for ESS can include a variety of high yield, evidence‐based interventions that would likely improve surgical outcomes and patient satisfaction.

show abstract

When is Antibiotic Prophylaxis for Nasal Packing Indicated?

Cited by 2 publications

References 5 publications

Rhinologist Use of Antibiotics With Nasal Packing for Epistaxis

Rhinologist Use of Antibiotics With Nasal Packing for Epistaxis

Enhanced recovery after endoscopic sinus surgery: Establishing comprehensive protocols for improvement of perioperative patient care

Contact Info

Product

Resources

About