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Epistaxis - Management
Basis for recommendation

Topical treatments

  • The recommendation to consider Naseptin® antiseptic cream is based on expert opinion in review articles [Pashen and Stevens, 2002; Wormald, 2002; Pope and Hobbs, 2005]. The suggested dose regimen is that suggested by the manufacturer's Summary of Product Characteristics [ABPI Medicines Compendium, 2009]. It was the opinion of CKS expert reviewers that a twice-daily regimen for up to 2 weeks is acceptable.
  • The available evidence is of low quality and is inconclusive as to the effectiveness of topical treatments for recurrent epistaxis. CKS found no placebo-controlled trials, and most studies included only children. The results of studies were not statistically significant.
  • Mupirocin nasal ointment is not recommended first-line because it is generally held in reserve for the elimination of staphylococci in resistant cases [BNF 59, 2010]. The suggested dose regimen is from the manufacturer's Summary of Product Characteristics [ABPI Medicines Compendium, 2010].

Nasal cautery

  • The recommendation to consider nasal cautery for recurrent epistaxis is based on low-quality evidence from two small trials. These found that Naseptin® antiseptic cream and silver nitrate cautery are of similar efficacy in improving symptoms of recurrent epistaxis. One study found a statistically significant improvement in symptoms with silver nitrate cautery followed by antiseptic nasal cream compared with sham cautery followed by antiseptic nasal cream [Murthy et al, 1999; Burton and Doree, 2004].

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