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Nasal Decolonisation / Recurrent Epistaxis Pregnancy: Topical use considered acceptable — minimal systemic absorption; used in pregnancy for epistaxis prevention

Naseptin Nasal Cream

Brand names: Naseptin

Adult dose

Dose: Small amount applied inside each nostril
Route: Intranasal (topical)
Frequency: Four times daily for 10 days (decolonisation); twice daily (long-term — recurrent epistaxis prevention)
Max: Four times daily application
Contains chlorhexidine 0.1% + neomycin 0.5%. Used for: (1) MRSA/Staphylococcus aureus nasal decolonisation pre-operatively; (2) prevention of recurrent anterior epistaxis (moisturises Little's area and provides antibacterial effect to reduce nasal crusting and picking). Also used post-nasal surgery.

Paediatric dose

Dose: Small amount per nostril application/kg
Route: Intranasal
Frequency: Four times daily for 10 days
Max: Same as adults
BNFc: licensed in children. Apply with cotton bud or fingertip inside nares. Avoid in neonates — chlorhexidine absorption risk.

Dose adjustments

Renal

No dose adjustment required (topical)

Hepatic

No dose adjustment required

Paediatric weight-based calculator

BNFc: licensed in children. Apply with cotton bud or fingertip inside nares. Avoid in neonates — chlorhexidine absorption risk.

Clinical pearls

  • Pre-surgical MRSA decolonisation: standard 5-day protocol — Naseptin QDS (nose) + chlorhexidine body wash; reduces surgical site infection rate
  • Recurrent epistaxis prevention: antiseptic/moisturising nasal cream applied twice daily reduces crusting and the urge to pick — targets the cycle of Kiesselbach's plexus trauma
  • Neomycin component: aminoglycoside; sensitisation occurs with repeated long-term use — consider alternatives if contact dermatitis develops
  • Contains arachis (peanut) oil in the original formulation — check for peanut/soya allergy before prescribing; alternatives without arachis oil are available
  • Not effective for MRSA decolonisation alone — mupirocin nasal ointment (Bactroban) is superior for MRSA decolonisation (targets MRSA specifically); Naseptin used for general Staph aureus decolonisation

Contraindications

  • Neomycin hypersensitivity or allergy to aminoglycosides
  • Peanut/soya allergy (contains arachis oil — check formulation)
  • Perforated tympanic membrane (if used near ear)

Side effects

  • Local irritation
  • Contact sensitisation to neomycin (with prolonged use)
  • Skin dryness

Interactions

  • Negligible at topical doses

Monitoring

  • Decolonisation swab (post-treatment)
  • Skin sensitisation (prolonged use)

Reference: BNFc; BNF 90; BNFc; NICE Surgical Site Infection (SSI) Prevention Guidance; PHE MRSA Decolonisation Protocol. Verify against your local formulary and the latest BNF before prescribing.

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Curated clinical cross-links plus same-class fallbacks.

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