Otitis externa
- Topical treatment
- Review at 7 days
- Consider cleaning the external auditory canal ('aural toilet'), to enable topical treatments to be applied effectively (i.e. dry swabbing or ear irrigation in intact tympanic membrane)
Early uncomplicated (or if perforated tympanic membrane)
Topical ciprofloxacin 0.3% ear drops two to three drops bd
If corticosteroid required: Topical ciprofloxacin (0.3%) and dexamethasone (0.1%) ear drops (Cilodex®) four drops bd
When ear canal is obliterated with granulation tissue / polyps
Topical gentamicin 0.3% with hydrocortisone 1% (Gentisone-HC®) ear drops two to three drops tds
OR Topical framycetin 0.5% with dexamethasone 0.05% (Sofradex®) ear drops two to three drops tds
NB Sofradex® also contains gramicidin 0.005%
Do NOT use aminoglycoside-based antibiotics (gentamicin, neomycin, framycetin) in patients with a perforated tympanic membrane due to the risk of ototoxicity, unless advised by a specialist.
When fungal infection is suspected
Topical clotrimazole 1% (Canesten®) solution two to three drops into the ear tds
OR Topical clioquinol 1% with flumetasone 0.02% (Locorten-Vioform®) two to three drops into the ear bd