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12. 1 Drugs acting on the ear

First line drugs Second line drugs Specialist drugs Secondary care drugs

12.1.1 Otitis externa       

Note: Local specialists consider a solution of acetic acid 2% as a first line preparation. It acts as an antifungal and antibacterial in the external ear canal, although there is no evidence to support this. It may be used to treat mild otitis externa but in several cases an anti-inflammatory preparation with or without an anti-infective drug is required. A proprietary preparation (EarCalm® spray) is on sale to the public.

Anti-inflammatory preparations

Betamethasone

  • Ear drops 0.1%           

Notes:

  • Prolonged use of topical corticosteroids should be avoided.
  • Betamethasone products for use in nasal allergy please refer to 12.2.1

Anti-infective preparations       

Clotrimazole

  • Solution 1%

Gentamicin

  • Ear drop 0.3%     

Ciprofloxacin

  • Eye drops 0.3% (see note below) (unlicensed)     

Notes:

  • Consideration should be given to the fact that pseudomonal resistance to aminoglycoside antibiotics is growing.
  • Ear swabs for culture should be reserved for treatment failures or chronic cases. They may be carried out using a urethral swab.
  • If infection is present a topical anti-infective agent that is not usually used systemically (eg. neomycin or clioquinol) may be used, but for about a week as excessive use may resulti in fungal infections; these may be difficult to treat and require expert advice.
  • CSM reminder: treatment with a topical aminoglycoside antibiotic is contra-indicated in those with a tympanic perforation.
  • Fungal infections are usually difficult to treat and specialist referral should be considered if this is suspected.
  • Ciprofloxacin is included for hospital use only. Aural use of ciprofloxacin 0.3% is unlicensed.       

Anti-infective plus anti-inflammatory combination preparations

Locorten-Vioform®

  • Ear drops: flumetasone pivalate 0.02%, clioquinol 1%       

Gentisone HC®

  • Ear drops: hydrocortisone acetate 1%, gentamicin 0.3%       

Otomize®

  • Ear Spray: dexamethasone 0.1%, neomycin sulphate 3250 units/ml, glacial acetic acid 2%

Sofradex®

  • Ear drops: Dexamethasone 0.05%, framycetin sulphate 0.5%, gramicidin 0.005%       

Notes:

  • Anti-infective and anti-inflammatory combination products may be used for infections with inflammation/eczema. However, the combination products usually include an aminoglycoside so careful consideration should be made before prescribing these.
  • Sofradex® is considered to be less suitable for prescribing as it contains an aminoglycosides (see BNF). This is linked to growing pseudomonal resistance. Sofradex® is reserved for use in hospital only where other preparations are not effective.

12.1.2 Otitis media       

For prescribing information refer to ‘Antimicrobial Guidelines for Primary Care’ (Chapter 5).       

12.1.3 Removal of ear wax       

Olive Oil   N

  • Ear drops        

Sodium bicarbonate

  • Ear drops 5%       

Notes:

  • Olive oil eardrops are considered as the standard first line product for the removal of earwax. It is extremely cheap and skin reactions to it are almost unheard of.
  • Sodium bicarbonate occasionally causes irritation.
  • Some proprietary preparations contain organic solvents which may cause irritation e.g. Cerumol®, and are not recommended. (See BNF)
  • All preparations for removal of earwax listed in the BNF are available over the counter at a cost less than the current prescription charge.

Return to Chapter: 12. Ear, Nose and Oropharynx

Last updated by: Carol Webb on 18-10-2012 11:50