https://cks.nice.org.uk/topics/otitis-externa/

For mild case:

• Acetic acid 2% (Earcalm) can be purchased over the counter

If red and swollen with minimal discharge:

• Lower potency steroid: Prednisolone sodium phosphate 0.5% drops
• Higher potency steroid: Betamethasone sodium phosphate 0.1% drops

If discharge/debris prevents product application, consider cleaning the ear canal first.

• Combined steroid + anti-infective product:
  • Betnesol N
  • Otomize

For fungal infections:

• Clotrimazole 1% solution

Investigations are rarely helpful but consider an ear swab if treatment fails or otitis externa occurs frequently

• Olive oil drops
• Sodium bicarbonate ear drops

• Naseptin cream (contains peanut oil)
• Fucidin Cream

For MRSA decolonisation regimes see beacon

Nasal decolonisation of MRSA:

• Mupirocin nasal (Bactroban nasal)

• Beclomethasone dipropionate 50micrograms per 1 dose nasal spray
• Mometasone furoate 50micrograms per 1 dose nasal spray

4.1 Dry mouth

https://bnf.nice.org.uk/treatment-summary/treatment-of-dry-mouth.html

• Xerotin Oral spray
• Biotene oralbalance Gel
• Salivix Pastilles

4.2 Oral hygiene

• Chlorhexidine mouthwash
• Hydrogen peroxide Mouthwash BP (Vincent’s infection)

4.3 Oral ulceration and inflammation

• Saline mouthwash made with warm water for mild cases
• Benzydamine oral rinse
• Benzydamine oromucosal spray +/- Chlorhexidine mouthwash (for secondary bacterial infections)
• Hydrocortisone muco-adhesive buccal tablets
• Beclomethasone 500microgram soluble tablets as a mouthwash
• Beclomethasone inhaler (unlicensed use – apply directly to the lesion)

4.4 Oral bacterial infection

See antimicrobial guidelines and

BNF https://bnf.nice.org.uk/treatment-summary/oropharyngeal-infections-antibacterial-therapy.html

4.5 Oral fungal infection

• Nystatin Suspension
• Miconazole oromucosal gel
• Fluconazole capsules when topical not sutable or lesions non-reponsive to topical treatment