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Epistaxis - Management
How should I manage recurrent epistaxis?
- If the person is not at high risk of having a serious cause of epistaxis, discuss treatment options for recurrent epistaxis.
- Topical treatment with antiseptic cream to reduce crusting and vestibulitis. This may be particularly useful in children, as it is easier to tolerate than nasal cautery.
- Prescribe Naseptin® cream first-line. It should be applied to the nostrils four times daily for 10 days (if compliance is a problem, experts suggest it can be used twice daily for up to 2 weeks). Do not prescribe Naseptin® for people known to be allergic to peanuts as it contains arachis oil (peanut oil).
- If the person is allergic to peanuts or neomycin, consider prescribing mupirocin nasal ointment. Apply to the nostrils two to three times a day for 5–7 days.
- Nasal cautery is similarly effective to Naseptin® antiseptic cream, but may be more uncomfortable. Consider it for use in primary care only if:
- The appropriate expertise and facilities (good lighting, topical anaesthetic spray, and nasal speculum) are available.
- The bleeding point can be identified.
- It can be tolerated (for example adults and older children, but not younger children).
- If epistaxis does not improve with antiseptic cream or nasal cautery, consider referral.
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