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Notes for: Otitis Externa
Last edited [13/08/2013 14:58:52]

Astringent preparations

A solution of acetic acid acts as an antifungal and antibacterial agent in the external ear canal. A proprietary preparation (EarCalm® spray) is on sale to the public. It may be used to treat mild otitis externa but where there are more significant signs, treatment should include Aural Care (microsuction of the ear) and an anti-infective / anti-inflammatory ear drop.

Anti-inflammatory preparations

1. Prolonged use of topical corticosteroids should be used only following specialist advice.

2. Although mometasone is licensed for use on the scalp, this product is also used in the management of Chronic Otitis Externa. Patients are instructed to use one or two drops in the affected ear once daily. It may cause stinging as it is in an alcoholic solution.

Anti-infective preparations

1. Consideration should be given to the fact that pseudomonal resistance to aminoglycoside antibiotics is growing.

2. Ear swabs for culture should be reserved for treatment failures or chronic cases. They may be carried out using a urethral swab.

3. If infection is present a topical anti-infective agent that is not usually used systemically is indicated. It should be used for approximately one week only, to prevent fungal overgrowth or resistance.

4. The CSM have issued a reminder that treatment with a topical aminoglycoside antibiotic is contra-indicated in those with a tympanic perforation. The BNF advises that many specialists do use these drops cautiously in the presence of a perforation in patients with otitis media and where other measures have failed for otitis externa.

5. Ciprofloxacin is included for use with specialist input. Aural use of ciprofloxacin 0.3% is unlicensed.

Anti-infective plus anti-inflammatory combination preparations

1. Sofradex® is considered to be less suitable for prescribing as it contains two different aminoglycosides (see BNF). This is linked to growing pseudomonal resistance. Sofradex® is reserved for use where other preparations are not effective.

2. Locorten-Vioform®, which is oil based, does not penetrate well when watery discharge is present (hence do not use in acute infection or acute on chronic infections).


Cornwall Joint Formulary Recommended Choices     (...Top)
Displaying 10 Drugs

First Line Drugs First Line Drugs
Second Line Drugs Second Line Drugs
Specialist Initiated Drugs Specialist Initiated Drugs
Hospital Only Drugs Hospital Only Drugs
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Antibiotics Antibiotics

NameTariffBNF Sub Paragraph
Betamethasone ear/eye/nose drops (Betnesol)
0.1 % drops (10 mil unit) Pack of 1
£2.32PCT FORMULARY STATUSFirst Line Drugs Otitis Externa
View BNF Article on 'Betamethasone ear/eye/nose drops'View SPC on 'Betamethasone ear/eye/nose drops'View PIL on 'Betamethasone ear/eye/nose drops'
Betamethasone / Neomycin Eye Drops (Betnesol N)
0.1 % / 0.5% drops (10ml unit) Pack of 1
£2.39PCT FORMULARY STATUS: First Line Drugs Otitis ExternaView BNF Article on 'Betamethasone / Neomycin Eye Drops'View SPC on 'Betamethasone / Neomycin Eye Drops'View PIL on 'Betamethasone / Neomycin Eye Drops'
Acetic Acid (Glacial) (Earcalm)
2 % spray (5ml unit) Pack of 5
£4.67PCT FORMULARY STATUS: First Line Drugs Otitis ExternaView BNF Article on 'Acetic Acid (Glacial)'View SPC on 'Acetic Acid (Glacial)'View PIL on 'Acetic Acid (Glacial)'
Gentamicin/ Hydrocortisone (Gentisone HC Ear Drops)
0.3 /1% drops 10ml unit Pack of 1
£4.76PCT FORMULARY STATUS: First Line Drugs Otitis ExternaView BNF Article on 'Gentamicin/ Hydrocortisone'View SPC on 'Gentamicin/ Hydrocortisone'View PIL on 'Gentamicin/ Hydrocortisone'
Gentamicin Ear/Eye Drops (Genticin)
0.3 % drops (10ml unit) Pack of 10
£25.55PCT FORMULARY STATUSFirst Line Drugs Otitis ExternaView BNF Article on 'Gentamicin Ear/Eye Drops'View SPC on 'Gentamicin Ear/Eye Drops'View PIL on 'Gentamicin Ear/Eye Drops'
Flumetasone / Cliquinol Ear Drops (Locorten-Vioform)
0.02 % / 1% (7.5ml unit) Pack of 7
£1.76PCT FORMULARY STATUS: Second Line Drugs Otitis ExternaView BNF Article on 'Flumetasone / Cliquinol Ear Drops'View SPC on 'Flumetasone / Cliquinol Ear Drops'View PIL on 'Flumetasone / Cliquinol Ear Drops'
Dexamethasone / Neomycin Ear Spray (Otomize Spray )
5 ml Unit Pack of 1
£3.27PCT FORMULARY STATUS: Second Line Drugs Otitis ExternaView BNF Article on 'Dexamethasone / Neomycin Ear Spray'View SPC on 'Dexamethasone / Neomycin Ear Spray'View PIL on 'Dexamethasone / Neomycin Ear Spray'
Sofradex Ointment
5 g tube Pack of 1
£3.46PCT FORMULARY STATUS: Second Line Drugs Otitis ExternaView BNF Article on 'Sofradex Ointment'View SPC on 'Sofradex Ointment'View PIL on 'Sofradex Ointment'
Sofradex Ear / Eye Drops
10 ml unit ear drops Pack of 1
£7.50PCT FORMULARY STATUS: Second Line Drugs Otitis ExternaView BNF Article on 'Sofradex Ear / Eye Drops'View SPC on 'Sofradex Ear / Eye Drops'View PIL on 'Sofradex Ear / Eye Drops'
Ciprofloxacin Eye Drops (Ciloxan)
0.3 % eye drops 5ml unit Pack of 1
- PCT FORMULARY STATUSSpecialist Initiated Drugs Otitis ExternaView BNF Article on 'Ciprofloxacin Eye Drops'View SPC on 'Ciprofloxacin Eye Drops'View PIL on 'Ciprofloxacin Eye Drops'

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