Otitis externa

Micro Organisms

Staph. aureus, Pseudomonas aeruginosa, Fungal (Candida spp, airborne fungi)


Bacterial duration 3-5 days, fungal duration – 14 days after resolution of infection

  • Send aspirate or swab
Otitis externa - Staphylococcus aureus

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


  • 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)
Otitis externa - Pseudomonas aeruginosa

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)

Gentamicin is contra-indicated in patients wiith a perforated tympanic membrane.

Otitis externa - Fungal

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)