Otitis Externa

Micro-organism

Staph. aureus, Pseudomonas aeruginosa, Candida spp., airborne fungi

Staph aureus

Aural toilet + analgesia

Topical Acetic Acid 2% 1 spray TDS and warm compresses for 7 days

 

Second Line

Gentisone HC (Gentamicin 0.3% + Hydrocortisone 1%) ear drops

Send aspirate or swab. Gentamicin is contra-indicated in patients with a perforated tympanic membrane

Pseudomonas aeruginosa

Aural toilet and analgesia

Topical Acetic Acid 2% for 3-5 days + warm compresses

Second Line:

*Ciprofloxacin 0.3% eye drops - apply 2 drops into the ear TDS

or

Gentisone HC (Gentamicin 0.3% + Hydrocortisone 1%) ear drops

 

Gentamicin is contra-indicated in patients with a perforated tympanic membrane

Seek ENT and microbiology advice

*There are no licensed ciprofloxacin ear drops available in the UK. Ciprofloxacin eye drops can be used off-label in the ear. The dose is based on advice from ENT.

 

Malignant Otitis Externa

Piperacillin / Tazobactam IV 6 hourly

If mild intolerance or mild skin reaction to penicillins - Ceftazadime IV (high dose as per BNFC)

If anaphylaxis (including severe skin reactions) to penicillins / cephalosporins - Gentamicin IV + Ciprofloxacin IV (high dose as per BNFC)

Ensure dose and frequency of antibiotics are adequate to treat Pseudomonas aeruginosa

ENT review advised

Fungal

Aural toilet + Clotrimazole 1% solution for at least 14 days after infection has resolved.

Seek specialist advice if required

Notes

Seek ENT and microbiology advice

CKS - Otitis Externa