Otitis externa

Analgesia and localised heat

One spray every 8 hours for 7 days

Otomize ear spray should only be used if the eardrum is not perforated

One spray every 8 hours for 7 days

If fungal infection

Apply every 8-12 hours continuing for at least 14 days after disappearance of infection

If cellulitis or disease extending outside ear canal.

500mg 6 hourly for 7 days

If allergic to penicillin

200mg on day 1, then 100mg daily for 5 days treatment in total

Prescribing Notes:

Many cases respond to ear toilet alone, with or without the addition of astringent drops.
In recurrent or persistent otitis externa, send a swab; recurrent cases may be due to fungal or Pseudomonas infection.
In mild inflammation or infection topical acetic acid 2% may be used to treat otitis externa. In more severe cases with suspected bacterial infection and eczematous inflammation a topical antibiotic with steroids is indicated.
If cellulitis/disease extending outside ear canal refer to ENT to exclude malignant otitis externa.
In patients with severe infection consider malignant otitis externa due to Pseudomonas. This requires prompt systemic antibiotics; Refer to ENT specialist.

History Notes

15/12/2021

East Region Formulary content agreed.

Analgesics and localised heat (e.g. warm flannel).

One spray every 8 hours for 7 days.

Otomize ear spray should only be used if the eardrum is not perforated.

See BNFc for dose, duration 7 days.

Prescribing Notes:

Many cases respond to ear toilet alone, with or without the addition of astringent drops.
In mild inflammation or infection topical acetic acid 2% may be used to treat otitis externa.
In more severe cases with suspected bacterial infection and eczematous inflammation a topical antibiotic with steroids is indicated.
In patients with severe infection consider malignant otitis externa due to Pseudomonas. This requires prompt systemic antibiotics; Refer to ENT specialist.
For more information refer to NICE CKS: Otitis externa.

History Notes

15/01/2024

East Region Formulary content agreed.

Dose according to age and product licence.

Prescribing Notes:

Many cases respond to ear toilet alone, with or without the addition of astringent drops.
In mild inflammation or infection topical acetic acid 2% may be used to treat otitis externa.

Examples of Counselling Points
The patient should be advised efficacy is reduced if treatment extends beyond 1 week.

When to advise patient to contact GP
Otitis media in the last 6 weeks.
History of ear drum perforation.
Severe ear pain or pain lasting for more than 2 days.

History Notes

15/12/2021

New pathway created to align to 01/10/2021 NHS Pharmacy First Scotland - Approved List of Products.