West of Scotland Formulary
NHS Scotland

Otitis externa

The regional formulary will not cover all eventualities for infections medicines choices. As with any condition; patient specific factors and sensitivities need to be considered. Please consider this regional formulary advice alongside any relevant local Board guidelines.

NICE CKS: Acute otitis externa

Treatment of acute otitis externa

Analgesia and localised heat. Many cases respond to aural toilet alone, with or without the addition of astringent drops. See NICE CKS guidance for further information.

Acetic acid
Acetic acid (glacial) 2% ear spray

One spray every 8 hours for 7 days.

Dexamethasone + Neomycin + Acetic acid ear spray should only be used if the eardrum is not perforated.

Dexamethasone + Neomycin + Acetic acid
Dexamethasone 0.1% / Neomycin 0.5% / Acetic acid (glacial) 2% ear spray

One spray every 8 hours for 7 days.

If fungal infection.

Clotrimazole
Clotrimazole 1% solution

Apply every 8-12 hours continuing for at least 14 days after disappearance of infection.

If cellulitis or disease extending outside ear canal.

Flucloxacillin
Flucloxacillin 500mg capsules

500mg 6 hourly for 5 days.

Flucloxacillin 250mg/5ml oral solution

500mg 6 hourly for 5 days.

If allergic to penicillin.

Doxycycline
Doxycycline 100mg capsules

200mg on day 1, then 100mg daily for 5 days treatment in total.

Prescribing Notes:

  • In patients with severe infection or cellulitis/disease extending outside ear canal, consider malignant otitis externa due to Pseudomonas aeruginosa. This requires prompt systemic antibiotics; refer to ENT specialist.

History Notes

30/07/2026

Regional formulary chapter launched.