PRACTiCeTOOL Figure 2 Suggested treatment approach for patients in the community setting with epistaxis 89% of these patients had resolution of their epistaxis at 6 weeks' follow-up. It is not possible to differentiate whether this benefit was derived from either agent alone or if it was a combined effect of both products. Also, given that epistaxis is generally not thought to be an inflammatory condition, the benefits of a topical corticosteroid beyond the moisturizing effects of its vehicle cream alone are uncertain. If a steroid-based product is used, application should be limited (perhaps once weekly as studied) due to the ability of topical steroids to thin the mucosa with prolonged use as well as the concern regarding epistaxis being a common adverse effect of intranasal corticosteroids.17 C P J / R P C * M ay / J u n e 2 0 1 9 * V O L 1 5 2 , N O 3 Topical decongestants. Topical nasal decongestants are thought to be valuable agents in the management of acute epistaxis because of their direct and localized vasoconstriction of the blood vessels in the nasal cavity. Their place in therapy is largely limited to the acute phase of management, including prevention of acute recurrence in the days following the bleed. Both oxymetazoline and xylometazoline have been studied in this setting.18 One study found a 75% success rate with the use of oxymetazoline (strength not specified) 4 to 6 sprays per nostril given once followed by 2 sprays every 6 hours for 1 to 3 days in patients with posterior epistaxis,18 and another reported a 65% success rate with the use of 2 sprays per 169