REMEDY : BNSSG referral pathways & Joint Formulary

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BNSSG Paediatric Joint Formulary

12.1 Ear

Last edited: 20-02-2024

First line drugs Second line drugs Specialist drugs Secondary care drugs

12.1.1 Otitis externa


Betamethasone 0.1% / Neomycin 0.5% drops (Betnesol-N®) (TLS Green)

Hydrocortisone 1% / Gentamicin 0.3% drops (Gentisone HC®) (TLS Green)

Dexamethasone 0.05% / Framycetin 0.5% / Gramicidin 0.005% drops (Sofradex®) (TLS Green)

Gentamicin 0.3% ear/eye drops (TLS Green)

  • Specific indication - (in secondary care, only to be initiated by ENT)

Dexamethasone 0.1% / Neomycin 3250units/mL spray (Otomize®) (TLS Green)


Flumetasone pivalate 0.02% / Clioquinol 1% drops (Locorten-Vioform®) (TLS Green)

Clotrimazole 1% solution (TLS Green)

Ciprofloxacin 0.3% drops (TLS Green)

  • N.B. As there is not a licensed ciprofloxacin ear drop preparation, ciprofloxacin eye drops are used (unlicensed use)
  • Local Consultants recommend use with a topical steroid to improve effectiveness



Betamethasone 0.1% drops (TLS Green)

Prednisolone 0.5% drops (TLS Green)


12.1.2 Removal of ear wax

Sodium bicarbonate 5% drops (TLS Green)

Olive oil (TLS Green)


12.1.3 Otitis media

Analgesic / local anaesthetic

Phenazone / lidocaine hydrochloride ear drops solution (Otigo) (TLS Blue)

  • second line option for local symptomatic treatment and relief of pain in acute congestive otitis media
  • only for use if oral analgesia is insufficient, an immediate oral antibiotic prescription is not given, and there is no eardrum perforation or otorrhoea.