Topical Treatment

In children, it is normally the case that adequate first aid measures will stop bleeding. In this situation, inspection of the anterior nasal cavity will commonly reveal either crusting of the anterior nasal mucosa or a visible vessel.

Comparisons of application of antiseptic nasal cream (e.g. Naseptin) with silver nitrate cautery in children with recurrent epistaxis found no significant difference between the two in the frequency of recurrent bleeding. [25]

The use of silver nitrate cautery was also associated with greater pain. Children with recurrent nose bleeds and nasal crusting should, therefore, be treated with topical nasal antiseptic cream applied twice daily for 4 weeks. In the presence of a visible vessel on the septum, cauterisation with silver nitrate is recommended. [26]

Learning bite

Topical antiseptic cream is as effective as silver nitrate cautery in preventing further nosebleeds in children with recurrent epistaxis.

In adult patients especially on antiplatelet drugs (Aspirin), treatment with topical application of TXA soaked cotton pledget (500 mg TXA in 5 ml) is painless, rapid and effective approach to achieving hemostasis in anterior epistaxis who fail direct pressure and can be tried prior the placement of an anterior nasal pack with no evidence of serious adverse effects. [27]