When Is Antibiotic Prophylaxis for Nasal Packing Indicated?

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BACKGROUND

Antibiotic prophylaxis with nasal packing is routinely used by many physicians to prevent complications including infection and toxic shock syndrome. The evidence for this practice, however, is controversial. Nasal packing is most commonly used to control epistaxis or after sinonasal surgery. Multi-drug antibiotic resistance is possible, and potential severe adverse reactions, including Clostridium difficile colitis (CDC), Stevens-Johnson Syndrome, and anaphylaxis, may offset the potential benefit of prophylaxis. This review reexamines the current evidence for antibiotic prophylaxis with nasal packing.

BEST PRACTICE

Current literature on the use of antibiotic prophylaxis for nasal packing is underpowered when comparing complication rates. One study that circumvented study size challenges using a cost-effectiveness approach demonstrated that the benefits from routine antibiotic prophylaxis were outweighed by costs associated with managing complications. While current studies are underpowered, the best practice recommendation is not to routinely use prophylactic antibiotics with nasal packing, as antibiotic use does not appear to reduce complications and is not cost-effective. Prophylactic antibiotic use may be considered in immunocompromised patients, though larger studies are needed to determine if routine use is helpful in specific patient populations.