A PROSPECTIVE, SINGLE-BLIND, RANDOMIZED CONTROLLED TRIAL OF ANTISEPTIC CREAM FOR RECURRENT EPISTAXIS IN CHILDHOOD.

Kubba H, et al. Clin Otolaryngol 2001 Dec;26(6):465-8.

BACKGROUND: Epistaxis is common in children. Trials show antiseptic cream is as effective as cautery, but it is not known whether either is better than no treatment. We wished to know the efficacy of cream in children with recurrent epistaxis.

DESIGN: The design was a single-blind, prospective, randomized controlled trial set in the Otolaryngology clinic in a children's hospital. The participants were 103 children referred by their general practitioner for recurrent epistaxis. Excluded were those with suspected tumours, bleeding disorders or allergies to constituents of the cream. Referral letters were randomized to treatment and no treatment groups. Treatment was antiseptic cream to the nose twice daily for 4 weeks, which was prescribed by the general practitioner before clinic attendance. All children were given an appointment for 8 weeks after randomization. The main outcome measures were the proportion of children in each group with no epistaxis in the 4 weeks preceding clinic review.

RESULTS: Complete data were available for 88 (85%) of the children. Of the treatment group, 26/47 (55%) had no epistaxis in the 4 weeks before the clinic appointment. Of the controls, 12/41 (29%) had no epistaxis over the 4 weeks. This is a relative risk reduction of 47% for persistent bleeding (95% CI 9-69%) and an absolute risk reduction of 26% (95% CI 12-40%), giving a number needed to treat of 3.8 (95% CI 2.5-8.5).

CONCLUSION: We conclude that antiseptic cream is an effective treatment for recurrent epistaxis in children.

COMMENT: The most impressive point to this small study is that the number needed to treat is less than 4.