Abx for nasal packing?!

[europeman]

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Hi everyone. I'm a fellow surgeon (general/trauma) and critical care doc. I know a lot of you ask for prophylactic unasyn while u have nasal packing in. I understand the logic.... But is there any evidence to support that? At all? Or professional guidelines/recs from your peeps society? Thank you!

 

[ZagDoc]

No good evidence either way. There's older studies that estimate the incidence and various case reports and case series describing it. There's also studies looking at abx vs. no-abx with nasal packing which didnt find any cases of TSS, but they are underpowered studies. So it's a little bit voodoo, but given the seriousness of TSS, I think most tend to err on the side of caution.

 

[neutropeniaboy]

Unasyn? Crazy. Keflex max. Older series dealt with gauze and sponge packs, which get funky w/o abx.

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[Pir8DeacDoc]

You could make an argument the abx are as much for preventing an obstructive sinusitis as preventing TSS. I always use keflex but in the npo pt unasyn isn't outlandish. We all treat plenty of sinusitis pts with augmentin.

 

[bobby6]

Most are using Keflex to cover staph. It only takes that 1 patient who gets toxic shock syndrome with nasal packing for you to get hosed. Not sure how you could defend it in a lawsuit if you didn't prescribe antibiotics. Haven't seen any recent studies but all the major textbooks recommend it as if it is standard of care.