For treatment of acute sinusitis refer to Upper respiratory tract infections.

Nasal staphylococci

Neomycin with chlorhexidine hydrochloride

(0.5% + 0.1%)

• Nasal cream (£1.99 = 15g)

Indications

• Eradication or prevention of nasal carriage of staphylococci

Dose

• Eradication, apply to nostrils 4 times daily for 10 days
• Prevention, apply to nostrils twice daily

Notes

1. Healthcare professional communication (April 2023): Extra care regarding patient allergy status must be taken when prescribing and dispensing Naseptin nasal cream. Both the original formulation containing Arachis oil and a revised formulation without Arachis oil will be in circulation in the supply chain from April 2023 until November 2025. Verify if the patient has an allergy to peanut or to soya – if so, take care to dispense only the Arachis oil-free formulation.
   

Mupirocin

• Nasal ointment 2% (click here for preferred brand)

Indications

• Eradication of nasal carriage of staphylococci, including meticillin-resistant Staphylococcus aureus (MRSA),

Dose

• Apply 2–3 times daily to the inner surface of each nostril. A sample taken 2 days after treatment to confirm eradication. Course may be repeated once only if the sample is positive

Note

1. Mupirocin should ideally be kept in reserve to avoid resistance developing. It is particularly useful in a hospital setting to treat MRSA. To avoid the development of resistance, the treatment course should not exceed 7 days and the course not repeated on more than one occasion. Please seek advice from Infection Control or Microbiology.
2. Where a preferred brand is recommended for a particular presentation, prescribing by brand helps ensure cost-efficient use of local NHS resources (see preferred brand link above).

Other preparations

Cocaine CD

• 10% nasal spray (unlicensed preparation)

Notes

1. For use within South Devon and Torbay Foundation NHS Trust.

Lidocaine 5% with phenylephrine 0.5%

• Nasal spray

Epistaxis

Bismuth iodoform paraffin paste (BIPP)

• Paste
• Paste impregnated gauze