TOPLINE:

According to a cohort study, the use of prophylactic antibiotics in immunosuppressed patients who underwent anterior nasal packing (ANP) for spontaneous epistaxis showed no significant benefit in preventing clinically significant infections, with a similar risk for adverse drug events (ADEs) in those receiving vs not receiving antibiotics.

METHODOLOGY:

• Researchers conducted a retrospective propensity score-matched cohort study using 2004-2024 data from the TriNetX database to analyze adults who presented to the emergency department (ED) for epistaxis, underwent ANP, and had an immunosuppressive condition listed by the CDC.
• Patients were classified based on whether they received prophylactic antibiotics on the day of the ED visit or within 1 day after (antibiotic/intervention group; n = 1118; 59.5% men) or did not receive any antibiotics (control group; n = 1118; 57.6% men).
• The primary outcome was the 30-day rate of clinically significant infections, defined as toxic shock syndrome, facial cellulitis, sinusitis, and otitis media following the index ED visit. The secondary outcome was the 30-day rate of ADEs, including unspecified ADEs, penicillin-related effects, any diarrhea, and Clostridium difficile infection.

TAKEAWAY:

• Fewer patients in the control group than in the intervention group had clinically significant infections within 30 days (6.4% vs 7.4%; risk difference [RD], -0.01; P = .25).
• Toxic shock syndrome occurred in none of the patients in the control group vs in 0.9% of those in the intervention group (RD, -0.009). Rates of all other infections were similar between groups.
• ADEs occurred in fewer patients in the control group than in the intervention group, but the difference was not statistically significant (19.7% vs 22.1%; RD, -0.024; P = .09).
• Rates of C difficile infection and diarrhea were similar between groups (RDs, -0.005 and -0.028, respectively).

IN PRACTICE:

"Among individuals with immunosuppressed conditions who underwent anterior packing for spontaneous epistaxis, the prevalence for clinically significant infection was approximately 6%, while the overall rate of 30-day adverse drug events when prescribed antibiotics was 20%," the authors wrote. "Since there was a higher rate of adverse drug events than clinically significant infection among individuals with immunosuppressed conditions, we recommend clinicians to rely on more objective markers about patients' immunosuppressed status before prescribing prophylactic antibiotics in this vulnerable patient population," they added.

SOURCE:

The study was led by Quincy K. Tran, MD PhD, University of Maryland School of Medicine, Baltimore. It was published online on November 02 in The American Journal of Emergency Medicine.

LIMITATIONS:

The study lacked patient-level data to assess immune system function, and the use of International Classification of Diseases codes may not have accurately captured all clinically significant infections or ADEs. The study did not account for antibiotic exposure after the index ED visit, which may have influenced the reporting of ADEs in the control group. The study was underpowered to detect small between-group differences in clinically significant infections due to strict inclusion criteria and propensity score matching. The TriNetX platform lacked granularity regarding antibiotic duration, packing laterality, and packing types, which may have influenced prescribing decisions.

DISCLOSURES:

The study received no external or internal funding. The authors reported having no conflicts of interest.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.