Epistaxis - Nasal Packing
When nasal infection or colonisation with Staphylococcus aureus may be contributing to epistaxis, local treatment can be considered.
Outpatient
- Nasal swabs sent for culture, where possible
- No antimicrobials are indicated unless infection suspected
Preferred: Naseptin® (chlorhexidine + neomycin) nasal cream
Apply a small amount (about the size of a match head) to both nostrils BD for 5 days
NB: Contra-indicated if patient (or carer) has allergy to chlorhexidine, peanuts or soya
Alternative: Bactroban® (mupirocin (2% w/w mupirocin free acid)) nasal ointment
Apply a small amount (about the size of a match head) to both nostrils TDS for 5 days
Prolonged/In patient
Preferred: Naseptin® (chlorhexidine + neomycin) nasal cream
Apply a small amount (about the size of a match head) to both nostrils BD for 5 days
NB: Contra-indicated if patient (or carer) has allergy to chlorhexidine, peanuts or soya
Alternative: Bactroban® (mupirocin (2% w/w mupirocin free acid)) nasal ointment
Apply a small amount (about the size of a match head) to both nostrils TDS for 5 days
There is limited evidence on the use of antibiotics after nasal packing but antibiotics may be considered for an individual patient where nasal infection is suspected:
Preferred:
Flucloxacillin 500mg po qds for up to 3 days
Alternative for penicillin allergy (non-severe and severe):
Doxycycline 100mg po bd for up to 3 days