Antimicrobial prescribing: NHS Grampian, Orkney & Shetland
Important: Therapy
Send aspirate or swab
Otitis externa
Micro Organisms
Staph. aureus, Pseudomonas aeruginosa, Fungal (Candida spp, airborne fungi)
Duration
Bacterial duration 3-5 days, fungal duration – 14 days after resolution of infection
Important: Therapy
Mild case: Aural toilet + analgesia
More serious cases:
Topical Betnesol-N® (betamethasone 0.1% + neomycin 0.5%) ear drops apply 2 - 3 drops into ear 6 - 8 hourly for 3 - 5 days
Notes:
- Betnesol-N® is contra-indicated in patients with a perforated tympanic membrane.
- Products to consider in mild cases (in addition to aural toilet) include Sofradex®, Locorten-Vioform®.
- Consider systemic antibacterial if spreading cellulitis or patient systemically unwell (flucloxacillin or erythromycin)
Important: Therapy
Mild case: Aural toilet
+ Topical Gentamicin 0.3% ear drops apply 2-3 drops into ear 6 - 8 hourly and at night for 3-5 days
More serious infection:
Add Oral ciprofloxacin 750mg 12 hourly
(Seek ENT, medical microbiology advice)
Notes:
Gentamicin is contra-indicated in patients wiith a perforated tympanic membrane.
Avoid ciprofloxacin in frail elderly patients where possible due to CDI risk. Check important safety information in BNF & give MHRA patient information leaflet to patient
Important: Therapy
Aural toilet
+ Topical clotrimazole 1% solution instill 2 - 3 drops into the ear 8 - 12 hourly for at least 14 days after infection has resolved.
(Seek specialist advice if required)