Prophylactic systemic antibiotics for anterior epistaxis treated with nasal packing in the ED

被引:9
|
作者
Murano, Tiffany [1 ]
Brucato-Duncan, Debbie [2 ]
Ramdin, Christine [3 ]
Keller, Steven [3 ]
机构
[1] Rutgers New Jersey Med Sch, Dept Emergency Med, 185 South Orange Ave,E Level,Room C-643, Newark, NJ 07103 USA
[2] Univ Hosp, Dept Surg, Newark, NJ USA
[3] Rutgers New Jersey Med Sch, Dept Emergency Med, Newark, NJ 07103 USA
来源
关键词
Epistaxis; Prophylactic; Antibiotics; Anterior; Packing; MANAGEMENT; ENGLAND;
D O I
10.1016/j.ajem.2018.12.056
中图分类号
R4 [临床医学];
学科分类号
1002 ; 100602 ;
摘要
Background: Emergency Department (ED) patients presenting with spontaneous epistaxis who have anterior nasal packing are routinely prescribed systemic prophylactic antibiotics in spite of the lack of supporting evidence-based literature. Although there is literature that discusses infection rates with nasal packing for epistaxis and prophylactic antibiotics prescribing practices of otolaryngologists, this is the first study to our knowledge that examines the practices of emergency physicians. Objectives: The main objective of this study was to compare the infection rate between patients who were and were not prescribed prophylactic systemic antibiotics for anterior nasal packing in spontaneous epistaxis and to examine current management practices of antibiotic prescribing for these patients. Methods: A retrospective review of ED patients >= 18 years old with the discharge diagnosis of epistaxis was performed over a 5-year period. Patients who had multiple visits to the ED for epistaxis or recent nasal or sinus surgery were excluded. Results: Over half of the patients, 57/106 (53.7%), who had anterior packing were prescribed prophylactic systemic antibiotics. Of these patients, 69/106 (65%) returned for a follow-up visit. There were no documented infections for any of these patients regardless of whether or not they were prescribed antibiotics. There was no significant difference with respect to rate of infection found between these two groups (the p-value = 0.263). Conclusion: The absence of infection supports previous findings and suggests that prophylactic antibiotic use for nasal packing in spontaneous epistaxis patients is not necessary. Further randomized controlled studies are necessary to definitively support this practice change. (C) 2018 Elsevier Inc. All rights reserved.
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页码:726 / 729
页数:4
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