Otitis externa | Right Decisions

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Antimicrobial prescribing: NHS Grampian, Orkney & Shetland
Hospital Guidance for Adults
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Ear, nose and oropharynx
Otitis externa

Update your RDS mobile app to v4.7.1 to download toolkits even when website is down,

We are pleased to advise that deep linking capability, enabling users to directly download individual mobile toolkits, has now been released on the RDS mobile app. When you install the update, you will see that each toolkit has a small QR code icon the header area beside the search icon – see screenshot below. Clicking on this icon will open up a window with a full-size QR code and the alternative of a short URL for sharing with users. Instructions are provided.

You may need to actively install the update to install RDS app version 4.7.1 to see this improvement. Installing this update is also strongly recommended to get the full benefits of the new contingency arrangements – specifically, that if the RDS website should fail, you will still be able to download new mobile app toolkits.

To check your current RDS version, click on the three dots bottom right of the RDS app screen. This takes you to a “More” page where you will see the version number. To install latest updates:

On iPhones – go to the Apple store, click on your profile icon top right, scroll down to see the apps waiting to be updated and update the RDS app.

On Android phones – these can vary, but try going to the Google Play store, click on your profile icon top right, click on “Manage apps and device”, select and update the RDS app.

Please get in touch with ann.wales3@nhs.scot with any questions.

Micro Organisms

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

Duration

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

Notes

Important: Therapy

Send aspirate or swab

Notes:

Otitis externa - Staphylococcus aureus

Important: Therapy

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

Notes:

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

Important: Therapy

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)

Notes:

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

Avoid ciprofloxacin in frail elderly patients where possible due to CDI risk. Check important safety information in BNF & give MHRA patient information leaflet to patient

Otitis externa - Fungal

Important: Therapy

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)

Notes: