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Otitis externa - Management
View full scenario
How should I treat localized otitis externa?
- Treat pain with an analgesic and the application of local heat (e.g. a warm flannel).
- Treat infection with an oral antibiotic ONLY if there is severe infection, or the person is at high risk of severe infection, (e.g. they have poorly-controlled diabetes, or compromised immunity).
- Drain pus if it has collected and is causing severe pain and swelling.
- Advise on ear care and hygiene.
In depth
What follow up is recommended for localized otitis externa?
- No follow up is necessary for most cases of acute localized otitis externa as they are mild and self limiting.
- Consider follow up if an antibiotic has been prescribed, or if there are risk factors such as insulin-dependent diabetes or compromised immunity.
In depth
When should I refer or seek specialist advice for someone with localized otitis externa?
- Consider referral to secondary care:
- If relief of pain and swelling requires incision and drainage of the furuncle, and the resources and skills are not available in primary care.
- If there is inadequate response to oral antibiotic treatment.
- If cellulitis is spreading outside the auditory canal.
In depth
Prescriptions
Analgesia: use when required
Age from 3 to 5 months
Ibuprofen s/f susp: 50mg three times a day
Ibuprofen 100mg/5ml oral suspension sugar free
Take 2.5ml three times a day when required for pain relief. Do not exceed the stated dose.
Supply 50 ml.
Age from 3 to 11 months
Paracetamol s/f susp: 60mg to 120mg up to four times a day
Paracetamol 120mg/5ml oral suspension paediatric sugar free
Take 2.5ml to 5ml every 4 to 6 hours when required for pain relief. Maximum of 4 doses in 24 hours.
Supply 150 ml.
Age from 6 to 11 months
Ibuprofen s/f susp: 50mg three to four times a day
Ibuprofen 100mg/5ml oral suspension sugar free
Take 2.5ml three to four times a day when required for pain relief. Do not exceed the stated dose.
Supply 100 ml.
Age from 1 year to 3 years 11 months
Ibuprofen s/f susp: 100mg three times a day
Ibuprofen 100mg/5ml oral suspension sugar free
Take one 5ml spoonful three times a day when required for pain relief. Do not exceed the stated dose.
Supply 100 ml.
Age from 1 year to 5 years 11 months
Paracetamol s/f susp: 120mg to 240mg up to four times a day
Paracetamol 120mg/5ml oral suspension paediatric sugar free
Take one to two 5ml spoonfuls every 4 to 6 hours when required for pain relief. Maximum of 4 doses in 24 hours.
Supply 300 ml.
Age from 4 years to 6 years 11 months
Ibuprofen s/f susp: 150mg three times a day
Ibuprofen 100mg/5ml oral suspension sugar free
Take 7.5ml three times a day when required for pain relief. Do not exceed the stated dose.
Supply 150 ml.
Age from 6 years to 11 years 11 months
Paracetamol s/f susp: 250mg to 500mg up to four times a day
Paracetamol 250mg/5ml oral suspension sugar free
Take one to two 5ml spoonfuls every 4 to 6 hours when required for pain relief. Maximum of 4 doses in 24 hours.
Supply 300 ml.
Age from 7 years to 9 years 11 months
Ibuprofen s/f susp: 200mg up to three times a day
Ibuprofen 100mg/5ml oral suspension sugar free
Take two 5ml spoonfuls three times a day when required for pain relief. Do not exceed the stated dose.
Supply 200 ml.
Age from 10 years to 11 years 11 months
Ibuprofen s/f susp: 300mg up to three times a day
Ibuprofen 100mg/5ml oral suspension sugar free
Take three 5ml spoonfuls three times a day when required for pain relief. Do not exceed the stated dose.
Supply 300 ml.
Age from 12 years to 17 years 11 months
Paracetamol tablets: 500mg to 1g up to four times a day
Paracetamol 500mg tablets
Take one or two tablets every 4 to 6 hours when required for pain relief. Maximum of 8 tablets in 24 hours.
Supply 50 tablets.
Ibuprofen tablets: 200mg to 400mg three to four times a day
Ibuprofen 200mg tablets
Take one or two tablets 3 to 4 times a day when required for pain relief. Do not exceed the stated dose.
Supply 56 tablets.
Age from 18 years onwards
Paracetamol tablets: 1g up to four times a day
Paracetamol 500mg tablets
Take two tablets every 4 to 6 hours when required for pain relief. Maximum of 8 tablets in 24 hours.
Supply 50 tablets.
Ibuprofen tablets: 400mg three times a day
Ibuprofen 400mg tablets
Take one tablet three times a day when required for pain relief. Do not exceed the stated dose.
Supply 21 tablets.
Add on if severe pain: codeine tablets
Codeine 30mg tablets
Take one to two tablets every 4 to 6 hours when required for additional pain relief. Maximum of 8 tablets in 24 hours.
Supply 28 tablets.
1st-line antibiotic: flucloxacillin for 7 days
Age from 3 months to 1 year 11 months
Flucloxacillin oral solution: 62.5mg four times a day
Flucloxacillin 125mg/5ml oral solution
Take 2.5ml four times a day for 7 days.
Supply 100 ml.
Flucloxacillin oral solution: 125mg four times a day
Flucloxacillin 125mg/5ml oral solution
Take one 5ml spoonful four times a day for 7 days.
Supply 200 ml.
Age from 2 years to 9 years 11 months
Flucloxacillin oral solution: 125mg four times a day
Flucloxacillin 125mg/5ml oral solution
Take one 5ml spoonful four times a day for 7 days.
Supply 200 ml.
Flucloxacillin oral solution: 250mg four times a day
Flucloxacillin 250mg/5ml oral solution
Take one 5ml spoonful four times a day for 7 days.
Supply 200 ml.
Age from 10 years to 11 years 11 months
Flucloxacillin oral solution: 250mg four times a day
Flucloxacillin 250mg/5ml oral solution
Take one 5ml spoonful four times a day for 7 days.
Supply 200 ml.
Flucloxacillin oral solution: 500mg four times a day
Flucloxacillin 250mg/5ml oral solution
Take two 5ml spoonfuls four times a day for 7 days.
Supply 300 ml.
Age from 12 years onwards
Flucloxacillin capsules: 250mg four times a day
Flucloxacillin 250mg capsules
Take one capsule four times a day for 7 days.
Supply 28 capsules.
Flucloxacillin capsules: 500mg four times a day
Flucloxacillin 500mg capsules
Take one capsule four times a day for 7 days.
Supply 28 capsules.
1st-line in penicillin allergy: erythromycin for 7 days
Age from 3 months to 1 year 11 months
Erythromycin s/f suspension: 125mg four times a day
Erythromycin ethyl succinate 125mg/5ml oral suspension sugar free
Take one 5ml spoonful four times a day for 7 days.
Supply 200 ml.
Erythromycin s/f suspension: 250mg four times a day
Erythromycin ethyl succinate 250mg/5ml oral suspension sugar free
Take one 5ml spoonful four times a day for 7 days.
Supply 200 ml.
Age from 2 years to 11 years 11 months
Erythromycin s/f suspension: 250mg four times a day
Erythromycin ethyl succinate 250mg/5ml oral suspension sugar free
Take one 5ml spoonful four times a day for 7 days.
Supply 200 ml.
Erythromycin s/f suspension: 500mg four times a day
Erythromycin ethyl succinate 500mg/5ml oral suspension sugar free
Take one 5ml spoonful four times a day for 7 days.
Supply 200 ml.
Age from 12 years onwards
Erythromycin gastro-resistant tablets: 250mg four times a day
Erythromycin 250mg gastro-resistant tablets
Take one tablet four times a day for 7 days.
Supply 28 tablets.
Erythromycin gastro-resistant tablets: 500mg four times a day
Erythromycin 250mg gastro-resistant tablets
Take two tablets four times a day for 7 days.
Supply 56 tablets.
2nd-choice in penicillin allergy: clarithromycin for 7 days
Age from 3 months to 3 years
Clarithromycin suspension: child weighs 7.9kg or less
Clarithromycin 125mg/5ml oral suspension
*WEIGHT REQUIRED* Take 7.5mg per kg bodyweight TWICE a day for 7 days.
Supply 70 ml.
Age from 3 months to 5 years
Clarithromycin suspension: child weighs 8kg to 11.9 kg
Clarithromycin 125mg/5ml oral suspension
Take 2.5ml twice a day for 7 days.
Supply 70 ml.
Age from 6 months to 7 years
Clarithromycin suspension: child weighs 12kg to 19.9kg
Clarithromycin 125mg/5ml oral suspension
Take one 5ml spoonful twice a day for 7 days.
Supply 70 ml.
Age from 3 to 10 years
Clarithromycin suspension: child weighs 20kg to 29.9kg
Clarithromycin 125mg/5ml oral suspension
Take 7.5ml twice a day for 7 days.
Supply 140 ml.
Age from 7 years to 11 years 11 months
Clarithromycin suspension: child weighs 30kg or more
Clarithromycin 250mg/5ml oral suspension
Take one 5ml spoonful twice a day for 7 days.
Supply 70 ml.
Age from 12 years onwards
Clarithromycin tablets: 250mg twice a day
Clarithromycin 250mg tablets
Take one tablet twice a day for 7 days.
Supply 14 tablets.
Clarithromycin tablets: 500mg twice a day
Clarithromycin 500mg tablets
Take one tablet twice a day for 7 days.
Supply 14 tablets.
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