GuidelinesPrimary Care STG
Otitis Externa
Otitis
Please click on the link below to access the most up-to-date version of this guideline. The content on this page is currently being updated to align with the latest publication. Always check the version number at the bottom of the screen to confirm which version you are using.
ICD-10 Code: H60.0/H60.5/H60.9
DESCRIPTION
Inflammation of the external ear may be one of the following:
- Diffuse: An infection of the ear canal, often due to Gram negative bacilli (especially P. aeruginosa). Pain is increased when chewing and the lining of the canal may be either inflamed or swollen with dry or moist debris or even a white or clear discharge
- Furuncular: Usually caused by Staphylococcus aureus. A painful localised swelling present at the entrance to the ear canal. May be precipitated by trauma caused by scratching, e.g. matchsticks, ear buds
GENERAL MEASURES
- Exclude any underlying suppurative otitis media. If supportive otitis media is diagnosed, see: Otitis media, chronic. supportive
- Most cases recover after thorough cleansing and drying of the ear
- Keep the ear clean and dry (dry mopping)
- Do not leave pieces of cotton wool, etc. in the ear
- Do not instil anything into the ear unless prescribed
MEDICINE TREATMENT
Diffuse
- Does not usually require an antibiotic
- Make a wick where possible, using ribbon gauze or other suitable absorbent cloth, e.g. paper towel to clean and dry the ear
- Acetic acid 2% in alcohol, topical, instilled into the ear every 6 hours for 5 days
- Instil 3–4 drops after cleaning and drying the ear
Furuncular
Children
- Cephalexin, oral, 12–25 mg/kg/dose 6 hourly for 5 days. See: dosing table
OR
- Flucloxacillin, oral, 12–25 mg/kg/dose 6 hourly for 5 days. See: dosing table
Children >7 years of age and adults
- Cephalexin, oral, 500 mg, 6 hourly for 5 days
OR
- Flucloxacillin, oral, 500 mg 6 hourly for 5 days
Severe penicillin allergy:
ICD-10 Code: Z88.0
Children
- Macrolide, e.g.:
- Azithromycin, oral, 10 mg/kg daily for 3 days. See dosing table
Children >35 kg and adults
- Macrolide, e.g.:
- Azithromycin, oral, 500 mg daily for 3 days
REFERRAL
- No response to treatment
Standard Treatment Guidelines and Essential Medicines List for South Africa, Primary Healthcare Level, 2024 Edition