Brain-eating amoeba death highlights importance of safe neti pot use

Protect your patients with neti pot counseling points

It’s right out of a horror movie: a woman’s brain is devoured by amoeba over the course of a year, and by the time it’s discovered, it’s too late to save her. A surgeon who operated on her told the Seattle Times that “a section of her brain about the size of a golf ball was bloody mush.” And it’s all because she used tap water in the neti pot she used to rinse her sinuses.

Neti pots have become increasingly popular for fighting congestion and allergies and to prevent colds.

“They're nondrug, they're natural, they actually are effective at cleaning out mucus build-up and allergens from the nose and the sinuses, and they are safe if you use them correctly,” said Kelly Scolaro, PharmD, associate professor at the Lake Erie College of Osteopathic Medicine Bradenton School of Pharmacy. She is an expert in self-care and nonprescription medications. Scolaro said that neti pots are a good option for “patients who are on a lot of drugs, like an elderly patient who is worried about drug–drug interactions and wants something for mucus relief but can't take pseudoephedrine.”

There are important counseling tips for patients who use neti pots.

“The three biggest things are keeping it clean, using the safe water source for the solution, and then, of course, using the proper technique so that they get a good rinse,” Scolaro said.

CDC recommends washing neti pots after each use. Depending on the manufacturer, some can be run through the dishwasher. “The minimum is to hand wash it with mild dish soap and hot water like any dish, and then either let it air dry or use nonlint towels,” Scolaro said. “You don't want to be putting lint in your nose because some people are allergic. If you suspect your neti pot has been contaminated, you can use a chlorine bleach solution.” Regardless of method, Scolaro tells pharmacists to urge that patients be sure to rinse the neti pot thoroughly to avoid soap residue going into the nose.

If pharmacists see a patient picking up a neti pot at the pharmacy, they can encourage the patient to also buy sterile or distilled water.  Pharmacists will "want to make sure that [patients] are using a safe water source. That way [patients] don’t have to boil their water as a new user,” Scolaro said. “Maybe [suggest] buying a prepared saline solution instead of making their own at first, until they get used to it.”

Use of safe water is imperative. The Seattle woman who died was using tap water run through a Brita filter.

FDA recommends that neti pot users boil tap water for 3 to 5 minutes and then cool to lukewarm before using. The agency also said that boiled and cooled water can be stored and safely used within 24 hours.

Certain filters can be effective to trap dangerous organisms, but in a factsheet, CDC specified that “the label [should] read ‘NSF 53’ or ‘NSF 58.’ Filter labels that read ‘absolute pore size of 1 micron or smaller’ are also effective.”

In addition, users can disinfect water with a chlorine bleach that is properly diluted.

Finally, pharmacists should assure patients that neti pots are safe if guidelines are followed. “When these news items hit—somebody dying from a neti pot—calm the patient. Tell them it's very rare, but deadly, and the way you avoid it is keeping your neti pot clean, using a safe water source, and making sure that patients understand what a safe water source is,” Scolaro urged.

Some patients should not use neti pots, such as patients with “a septal defect, defects in the nose or nasal mucosa or the sinuses, or someone who has an acute infection in the nose itself—if they’ve got a staph infection in the nose that's ongoing, and they've got a sore inside their nose, it's probably not a great idea unless they talk with their doctor about it,” Scolaro said. “For someone who had recent nasal surgery, maybe has open wounds or sutures in the nose, they may not want to use a neti pot without checking with their surgeon first.”

For any patient using a neti pot, “if for some reason, they start feeling like they’re having headache, fever, nausea, or vomiting, they need to contact their doctor right away,” Scolaro said.

CDC’s guidelines, including a one-page illustrated fact sheet, can be found at