Introduction: Recurrent anterior idiopathic epistaxis is common in children, yet optimal management remains debated. This
study compared the efficacy of antiseptic cream, antiseptic plus corticosteroid cream, and silver nitrate cautery in reducing epistaxis
severity in paediatric patients.
Methodology: In a prospective randomised dual-centre clinical trial, 136 children with recurrent idiopathic anterior epistaxis were
evenly allocated to antiseptic cream, antiseptic plus corticosteroid cream, or silver nitrate cautery. Epistaxis Severity Score was assessed
at baseline, 2 weeks, and 1, 3, and 6 months.
Results: All groups showed significant reductions in ESS over time. At 2 weeks, silver nitrate cautery produced the most rapid early
improvement, compared with antiseptic cream and the combination cream. By 1 month, the antiseptic plus corticosteroid group
showed the greatest improvement, with further reductions at 3 months and 6 months. At 6 months, improvement rates were
highest with the combination therapy, followed by antiseptic cream and cautery.
Conclusions: Cautery achieves rapid short-term control, but antiseptic plus corticosteroid cream provides the most durable
improvement following a short, two-week course. It should be considered a first-line therapy for recurrent idiopathic anterior
epistaxis in children.