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Acute otitis externa: Pharmacy First treatment summary
Ear pain, itching or discharge in adults: a summary of the Pharmacy First pathway for acute otitis externa in people aged 18 and over, from assessment to self-care
Local NHS route (if unavailable, general practice or urgent care)
●
Canal swelling that prevents examination or treatment1,2
General practice
●
Narrow canal, exostoses, osteoma or ear surgery that hinders drops2
●
Treatment failure, or severe or chronic infection2,3
Treatment options
First line
●
Acetic acid 2% (over the counter): morning, evening and after swimming or bathing, for up to 7 days3
Second line
●
Offer antibiotic ear drops only if OTC acetic acid 2% has failed despite correct use, was not tolerated or is unsuitable, and if the canal is open, and the patient can use drops after a demonstration1
●
Topical antibiotic, with or without a corticosteroid, for 7–14 days. Add a corticosteroid for marked inflammation or oedema3
Provide patient information: NHS website, ear infections1,4
Safety-netting advice for patient
●
Seek urgent help for fever or systemic illness, spreading redness, severe or disproportionate pain, new facial weakness, new vertigo, fluctuant swelling behind the ear or the ear pushed forwards1
●
Contact GP if symptoms worsen, have not started to improve within 72 hours, or have not resolved within 2 weeks1
Follow up
Reassess the patient if
●
No improvement within 48–72 hours (the pathway says 72) or not resolved after 2 weeks1,3
Record and share
●
Tell the GP the outcome, prescribing decision and any follow-up needed1,2
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