ENT
Otitis Media (Ear Discharge)
کان بہنا
Greenish or yellowish ear discharge with earache or a sense of a foreign body in the ear. Clear the ear, give topical antibiotic-anaesthetic drops if the tympanic membrane is intact, plus oral antibiotic, NSAID and antihistamine.
- ICD-10
- —
- Source
- OPD handbook pp.111–117
- Status
- Draft
Not yet reviewed by a clinician. Check doses and brands against current national guidelines before use.
Symptoms
- Ear discharge: greenish or yellowish
- Earache or sense of some foreign body in the ear
Diagnosis
- Examine the ear with an ear speculum: ear canal shows discharge in the middle ear
- Examine the tympanic membrane (TM): intact or perforated
- Examine vitals
Treatment
Step 1 of 7
1. Suctioning and clearance
- Ideally with a sucker machine
- If not available: gentle suctioning with a cotton bud, but never with a match-stick
Step 2 of 7
2. Topical antibiotic + local anaesthetic
- Cipocaine ear drops: ciprofloxacin + xylocaine/lignocaine (local anaesthetic)
- Drops are contraindicated if the TM is perforated
Prescription
Ciprofloxacin + Lignocaine (xylocaine) ear dropsTopical antibiotic + local anaesthetic
Dose3+3+3 drops (morning, noon, evening)
Brand Cipocaine ear drops
Step 3 of 7
3. Oral antibiotics (adults)
- Ciprofloxacin is the drug of choice
- Alternates: Augmentin 625 mg TDS, levofloxacin 250 mg BD, cefixime 400 mg OD, moxifloxacin 400 mg OD
Prescription
CiprofloxacinFluoroquinolone antibiotic
DoseBD (1+1)
Brand Tab Novidat 500 mg
7 days (sample)
Also sold as Novidat, Mercep, Cipro, Ciproxin, Ciprin
Amoxicillin + Clavulanic acidPenicillin antibiotic + β-lactamase inhibitor
DoseTDS
Brand Augmentin 625 mg
Also sold as Augmentin, Co-Amoxiclave, Calamox
Caution: Penicillin allergy; Cholestatic jaundice risk with prolonged use
LevofloxacinFluoroquinolone antibiotic
Dose250 mg BD
Brand Levofloxacin
Also sold as L-Cyn, Leflox, Efflox (spelling unclear in book), Levo
Cefixime3rd-generation cephalosporin
Dose400 mg OD
Brand Cefixime
Also sold as Cefspan, Cefim, Caricef, Tixomer, Cefiget
Rising resistance in Salmonella Typhi; not reliable as a sole agent in XDR typhoid.
MoxifloxacinFluoroquinolone antibiotic
Dose400 mg OD
Brand Moxifloxacin
Also sold as Mofest, Moxef, Avelox, Moxiget
Step 4 of 7
4. NSAIDs
Prescription
Step 5 of 7
5. Antihistamine
Prescription
CetirizineAntihistamine
DoseHS
Brand Tab Rigix 10 mg / Sedil 10 mg
Also sold as Rigix, Sedil, Antial, Neo-Antial, Cetrix, Zyrtec
Step 6 of 7
6. Paediatric doses
All syrups by weight/age as written in the book (TSF = teaspoonful).
- Ciprofloxacin (Syp Novidat 125 mg/5 mL), 20 mg/kg in two divided doses: 1 y, 10 kg → 1+1 tsf; 4–5 y, 13–14 kg → 1½+1½ tsf; 6–7 y, 18–20 kg → 2+2 tsf
- Augmentin (Syp 312.5 mg/5 mL), 30 mg/kg TDS: 1 y, 10 kg → 1+1+1 tsf; 3–4 y, 13–14 kg → 1½ ×3; 6–7 y, 18–20 kg → 2+2+2
- Caricef (Syp 100 mg/5 mL), 10 mg/kg OD: 1 y, 10 kg → 1 tsf daily; 3–4 y, 14–15 kg → 1½ tsf; 6–7 y, 18–20 kg → 2 tsf
- Genthro syrup 100 mg/5 mL: same as for Caricef (10 mg/kg OD)
- Brufen syrup 100 mg/5 mL, 10 mg/kg TDS: same as Caricef but TDS (1 y, 10 kg → 1+1+1 tsf)
- Tercica (dexibuprofen) 100 mg/5 mL, 5–10 mg/kg TDS: 10 kg/1 y → 1+1+1 tsf
- Sedil (cetirizine) 5 mg/5 mL: age under 2.5 y → ½ tsf at night; over 2.5 y → 1 tsf at night. Alternates: Rigix 5 mg/5 mL; T-Day 2.5 mg/5 mL (levocetirizine): under 2.5 y → 1 tsf HS; over 2.5 y → 2 tsf HS
Prescription
CiprofloxacinFluoroquinolone antibiotic
Dose20 mg/kg in 2 divided doses
Brand Syp Novidat 125 mg/5 mL
Also sold as Novidat, Mercep, Cipro, Ciproxin, Ciprin
Amoxicillin + Clavulanic acidPenicillin antibiotic + β-lactamase inhibitor
Dose30 mg/kg TDS
Brand Syp Augmentin 312.5 mg/5 mL
Also sold as Augmentin, Co-Amoxiclave, Calamox
Caution: Penicillin allergy; Cholestatic jaundice risk with prolonged use
Cefixime3rd-generation cephalosporin
Dose10 mg/kg OD
Brand Syp Caricef 100 mg/5 mL
Also sold as Cefspan, Cefim, Caricef, Tixomer, Cefiget
Rising resistance in Salmonella Typhi; not reliable as a sole agent in XDR typhoid.
AzithromycinMacrolide antibiotic
Dose10 mg/kg OD
Brand Syp Genthro 100 mg/5 mL
Also sold as Zithromax, Azomax, Azitma, Arzomic, Zyto, Genthro
Caution: QT prolongation; caution with other QT-prolonging drugs
IbuprofenNSAID
Dose10 mg/kg TDS
Brand Syp Brufen 100 mg/5 mL
Caution: Avoid in dengue (bleeding risk); Avoid in kidney disease, peptic ulcer, late pregnancy; Take with food
CetirizineAntihistamine
DoseUnder 2.5 y ½ tsf HS; over 2.5 y 1 tsf HS
Brand Syp Sedil / Rigix 5 mg/5 mL
Also sold as Rigix, Sedil, Antial, Neo-Antial, Cetrix, Zyrtec
LevocetirizineAntihistamine
DoseUnder 2.5 y 1 tsf HS; over 2.5 y 2 tsf HS
Brand Syp T-Day 2.5 mg/5 mL
Step 7 of 7
7. Counselling
- Keep the ear dry
- Do not put oil in the ear
- Apply oil on cotton and place it in the ear while bathing
- Children: keep the head raised while feeding milk; after feeding place the baby on the chest and pat
- No match-stick in the ear; avoid relatives' advice
Sample prescriptions from the book (patient details removed)
- Boy, 1.5 y, 10 kg, ear discharge and scratching the ear all the time with excessive crying; ear canal shows debris. Plan: suction with the machine. Rx: Cipocaine ear drops 2+2+2 drops; Syp Novidat 125 mg/5 mL 1+1 tsf (morning, evening); Syp Tercica 100 mg/5 mL 1+1+1 tsf; Syp T-Day 2.5 mg/5 mL 1 tsf at night.
- Female, 35 y, earache and discharge 1 week with mild itching; pinna non-tender; discharge in the middle ear; TM intact. Plan: suctioning and clearance. Rx: Tab Novidat 500 mg 1+1 for 7 days; Tab Neoprox 500 mg 1+1 for 7 days; Tab Rigix 10 mg at night; Cipocaine ear drops 3+3+3 drops; keep the ear dry, no water in the ear; no match-stick.