BNF for Children 2011-2012

BNFC 2011–2012 12.1.1 Otitis externa 535or without an anti-infective drug. A proprietary preparationcontaining acetic acid 2% (EarCalm c spray) is onsale to the public for children over 12 years.For severe pain associated with otitis externa, a simpleanalgesic, such as paracetamol (section 4.7.1) or ibuprofen(section 10.1.1), can be used. A systemic antibacterial(Table 1, section 5.1) can be used if there isspreading cellulitis or if the child is systemically unwell.When a resistant staphylococcal infection (a boil) ispresent in the external auditory canal, oral flucloxacillin(section 5.1.1.2) is the drug of choice; oral ciprofloxacin(section 5.1.12) or a systemic aminoglycosidemay be needed for pseudomonal infections, particularlyin children with diabetes or compromised immunity.The skin of the pinna adjacent to the ear canal is oftenaffected by eczema. A topical corticosteroid (section13.4) cream or ointment is then required, but prolongeduse should be avoided.Administration To administer ear drops, lay the childdown with the head turned to one side; for an infant pullthe earlobe back and down, for an older child pull theearlobe back and up.BETAMETHASONE SODIUMPHOSPHATECautions see notes aboveContra-indications see notes aboveSide-effects see notes aboveLicensed use licensed for use in children (age rangenot specified by manufacturers)Indication and doseEczematous inflammation in otitis externa (seenotes above); for dose, see under preparationsEye section 11.4.1Nose section 12.2.1 and section 12.2.3Betnesol c (UCB Pharma) ADrops (for ear, eye, or nose), betamethasone sodiumphosphate 0.1%. Net price 10 mL = £2.23Excipients include benzalkonium chloride, disodium edetateDoseear, instil 2–3 drops every 2–3 hours; reduce frequencywhen relief obtainedAstringent preparationsALUMINIUM ACETATELicensed use not licensedIndication and doseInflammation in otitis externa (see notes above)Insert into meatus or apply on a ribbon gauzedressing or sponge wick which should be keptsaturated with the ear dropsAluminium Acetate (Non-proprietary)Ear drops 13%, aluminium sulphate 2.25 g, calciumcarbonate 1 g, tartaric acid 450 mg, acetic acid (33%)2.5 mL, purified water 7.5 mLAvailable as manufactured specialEar drops 8%, dilute 8 parts aluminium acetate eardrops (13%) with 5 parts purified water. Must befreshly preparedAnti-inflammatory preparationsCorticosteroidsTopical corticosteroids are used to treat inflammationand eczema in otitis externa.Cautions Prolonged use of topical corticosteroid earpreparations should be avoided.Contra-indications Corticosteroid ear preparationsshould be avoided in the presence of an untreated earinfection. If infection is present, the corticosteroidshould be used in combination with a suitable antiinfective(see notes above).Side-effects Local sensitivity reactions may occur.Vistamethasone c (Martindale) ADrops (for ear, eye, or nose), betamethasone sodiumphosphate 0.1%. Net price 5 mL = £1.02; 10 mL =£1.16Excipients include benzalkonium chloride, disodium edetateDoseear, instil 2–3 drops every 3–4 hours; reduce frequencywhen relief obtainedWith antibacterialBetnesol-N c (UCB Pharma) ADrops (for ear, eye, or nose), betamethasone sodiumphosphate 0.1%, neomycin sulphate 0.5%. Net price10 mL = £2.30Excipients include benzalkonium chloride, disodium edetateDoseear, instil 2–3 drops 3–4 times dailyDEXAMETHASONECautions see notes aboveContra-indications see notes aboveSide-effects see notes aboveLicensed use Sofradex c licensed for use in children(age range not specified by manufacturers)Indication and doseEczematous inflammation in otitis externa (seenotes above); for dose, see under preparationsWith antibacterialOtomize c (GSK Consumer Healthcare) AEar spray, dexamethasone 0.1%, neomycin sulphate3250 units/mL, glacial acetic acid 2%. Net price 5-mLpump-action aerosol unit = £3.71Excipients include hydroxybenzoates (parabens)DoseChild 2–18 years ear, apply 1 metered spray 3 timesdaily12 Ear, nose, and oropharynx