Only consider oral antibiotics when disease extends outside of the ear canal or patient systemically unwell. Refer patient to ENT Betamethasone 0.1% plus 2-3 drops tds 7 days Children with OM effusion should not be treated with antibiotic / topical steroids / Neomycin 0.5% minimum decongestants or mucolytics. to max Diabetic and immunocompromised patients are particularly susceptible to or 14 days aggressive destruction of cartilage caused by Pseudomonas aeruginosa (“Malignant Otitis Externa”). If suspected, the patient should be referred urgently to Flumetasone pivalate 0.02% 2-3 drops bd 7 days an ENT specialist. plus Clioquinol 1% Cellulitis/systemically unwell Flucloxacillin 500mg qds 5-7 days (+ to ENT) If allergic to penicillin: Clarithromycin 500mg bd 5-7 days (+ to ENT) Otitis externa No antibacterial / antifungals needed chronic Keep clean and dry. – Indication Comment Drug Dose Duration Rhinosinusitis associated with viral infection or perennial rhinitis Acute / uncomplicated Acute or Avoid antibiotics as 80% resolve in 14 days without, and they only offer marginal Chronic benefit after 7 days (NNT 15) Choice: Use adequate analgesia No antibiotic Consider 7-day-delayed or immediate antibiotic when purulent nasal discharge (NNT 8). Second Choice In persistent rhinosinusitis an agent with anti-anaerobic activity will be required, Amoxicillin 500mg tds 7 days e.g. co-amoxiclav. If penicillin allergy then discuss with microbiologist 1g tds if severe For persistent symptoms consider referral to ENT or Phenoxymethylpenicillin 500mg qds 7 days If allergic to penicillin Doxycyycline stat then 100mg 7 days od or 7 days Clarithromycin 250mg to 500mg bd
Only consider oral antibiotics when disease extends outside of the ear canal or patient systemically unwell. Refer patient to ENT Children with OM effusion should not be treated with antibiotic / topical steroids / decongestants or mucolytics. Diabetic and immunocompromised patients are particularly susceptible to aggressive destruction of cartilage caused by Pseudomonas aeruginosa (“Malignant Otitis Externa”). If suspected, the patient should be referred urgently to an ENT specialist. Betamethasone 0.1% plus Neomycin 0.5% or Flumetasone pivalate 0.02% plus Clioquinol 1% Cellulitis/systemically unwell Flucloxacillin (+ to ENT) If allergic to penicillin: Clarithromycin (+ to ENT) 2-3 drops tds 2-3 drops bd 500mg qds 500mg bd 7 days minimum to max 14 days 7 days 5-7 days 5-7 days Otitis externa – chronic No antibacterial / antifungals needed Keep clean and dry. Indication Comment Drug Dose Duration Rhinosinusitis Acute or Chronic associated with viral infection or perennial rhinitis Avoid antibiotics as 80% resolve in 14 days without, and they only offer marginal benefit after 7 days (NNT 15) Use adequate analgesia Consider 7-day-delayed or immediate antibiotic when purulent nasal discharge (NNT 8). In persistent rhinosinusitis an agent with anti-anaerobic activity will be required, e.g. co-amoxiclav. If penicillin allergy then discuss with microbiologist For persistent symptoms consider referral to ENT Acute / uncomplicated Choice: No antibiotic Second Choice Amoxicillin or Phenoxymethylpenicillin If allergic to penicillin Doxycyycline or Clarithromycin 500mg tds 1g tds if severe 500mg qds stat then 100mg od 250mg to 500mg bd 7 days 7 days 7 days 7 days