Dawaa Reference

infectious

Acute otitis externa

Treatment options, dosing, cautions and Egyptian brands from the shipped Dawaa Reference card.

Evidence status

Checked against the sources named below

Sources7 sources

Egyptian National Drug Formulary - Antimicrobial 2023 · AAO-HNS Clinical Practice Guideline 2014 · Daktacort (miconazole 2% + hydrocortisone 1%) cream SmPC sections 4.1-4.2 (eMC product 1557) · Acute otitis externa - disease-level clinical article (otitis-externa-full.txt) · MSF Essential Drugs 2024 (paracetamol oral monograph) · MSF Essential Drugs 2024 (ibuprofen oral monograph) · Ofloxacin Otic Solution 0.3% - DailyMed prescribing information (Amneal Pharmaceuticals NY LLC)

Verified against6 documents
  • Egyptian National Drug Formulary - Antimicrobial 2023
  • Daktacort (miconazole 2% + hydrocortisone 1%) cream SmPC sections 4.1-4.2 (eMC product 1557)
  • Acute otitis externa - disease-level clinical article (otitis-externa-clinical.txt)
  • Acute otitis externa - disease-level clinical article (otitis-externa-full.txt)
  • MSF Essential Drugs 2024 (paracetamol oral monograph)
  • MSF Essential Drugs 2024 (ibuprofen oral monograph)

Verified date2026-08

Presentation reference

Is it this?

Reference only, to read alongside your own examination.

Symptoms — what the patient reports (4)

  • Itching and ear pain that worsens with pulling on the ear or pressing the tragus are the presenting complaints [ear pain · itching]
  • The pain is often out of proportion to how the ear canal looks, because the thin skin over the ear canal bone is very sensitive
  • Ear discharge, a plugged-up feeling, and hearing loss can also occur [ear discharge · hearing loss]
  • A fever over 101 F (38.3 C) with malaise suggests the infection has spread beyond the ear canal [fever · malaise]

Signs — what you find (5)

  • The ear canal looks red and swollen with yellow, white, or gray debris on otoscopy
  • The eardrum may look red or be hard to see fully because of canal swelling
  • Fluid visible behind the eardrum suggests otitis media is also present
  • In severe disease the canal is completely swollen shut, with intense pain, swollen nodes, and fever [fever]
  • Mild disease shows itching, mild discomfort, and canal swelling, while moderate disease has partial blockage of the canal [itching]

Tests (3)

  • Routine labs or ear cultures are not needed for a straightforward case
  • Cultures are reserved for infections that keep coming back or resist treatment, especially in immunocompromised patients
  • Blood glucose and HIV testing can be considered when symptoms are severe

If not this — what else fits (9)

  • In children, otitis media with a ruptured eardrum and drainage is an important item on the differential
  • If it is unclear whether this or otitis media with perforation is present, treating for both is reasonable
  • Contact dermatitis of the ear canal is on the differential
  • Psoriasis of the ear canal is on the differential
  • A boil (furunculosis) in the ear canal is on the differential
  • Herpes zoster oticus (Ramsay Hunt syndrome) is on the differential
  • TMJ syndrome can mimic ear pain and is on the differential
  • A retained foreign body in the ear canal is on the differential
  • Cancer of the ear canal is on the differential, particularly in resistant or unusual cases

SourceStatPearls "Otitis Externa" - disease-level clinical article

Presentation findings are traced to the source above.

Rx: Ciprofloxacin | Main treatment | Ofloxacin | Analgesia

CIPROFLOXACIN

1

CIPROFLOXACIN

Ciprofloxacin

1st line

Formear

Adult dose and duration

Instill 3-4 drops into affected ear twice daily x 7 days

Paediatric dose

(Children >1 year: 3 drops twice daily into affected ear for 7 days)

Dose by age
Over 1 year:3 drops twice daily into affected ear for 7 days
AWaRe

WATCH group - carries resistance cost. Egyptian EML 2025.

Dose source

Egyptian National Drug Formulary - Antimicrobial 2023

Why

Ciprofloxacin ear drops target the bacterial pathogens, commonly Pseudomonas and Staphylococcus species, that cause acute otitis externa; it is favored here because it is non-ototoxic and can be used safely even when the tympanic membrane is perforated.

Cautions
  • Keep ear canal dry during treatment.
  • Clean debris from ear canal prior to instillation.
  • Ciprofloxacin is safe with a perforated tympanic membrane (non-ototoxic).
Egyptian brands
Egyptian brandManufacturerIndicative price
CIPRO 0.3% EAR DROPS 10 MLCID15.00 EGP

MAIN TREATMENT - choose one

2

REFERRAL & SAFETY-NETTING (NO DRUG THERAPY)

1st line
Dose source

Otitis Externa - disease-level clinical article (otitis-externa-full.txt)

Why

Carries the referral criteria and warning signs for this condition, which apply whichever treatment is chosen.

Cautions
  • RED FLAG - Malignant (necrotizing) otitis externa should be suspected in diabetic or immunocompromised patients with OE and fever not responding to treatment - a life-threatening condition needing antipseudomonal antibiotics and urgent recognition.
  • RED FLAG - The indications requiring oral antibiotics or escalation beyond topical therapy are diabetes with increased morbidity, HIV/AIDS, suspected malignant otitis externa, and concomitant acute otitis media.
  • RED FLAG - If tympanic membrane perforation is suspected, ototoxic drops (aminoglycosides such as neomycin/polymyxin B, and alcohol-based preparations) must be avoided; fluoroquinolones are the recommended, non-ototoxic option.
  • RED FLAG - The ENT referral criteria are complete occlusion of the ear canal, no response to treatment within 72 hours, or suspected necrotizing otitis externa.
3

HYDROCORTISONE + MICONAZOLE

2nd line

Formtopical

Adult dose and duration

Apply the cream thinly to the outer ear canal twice daily x 7 days maximum

Paediatric dose

(Over 2 years: apply thinly to the outer canal twice daily, 7 days at most.)

Dose by age
Over 2 years:Apply thinly to the outer canal twice daily, for 7 days at most
Dose source

Daktacort (miconazole 2% + hydrocortisone 1%) cream SmPC sections 4.1-4.2 (eMC product 1557)

Why

This combines a topical antifungal, miconazole, with a corticosteroid, hydrocortisone, to treat the fungal or mixed bacterial-fungal component of otitis externa while calming the inflammation and itching of the ear canal.

Cautions
  • CONTRAINDICATED if tympanic membrane perforation is suspected.
  • Only for otitis externa where a fungal cause is suspected - not for otitis externa generally. The disease source does not treat a topical antifungal as first-line at all: it is reserved for the case where otoscopy or a culture points to fungus. (Otitis Externa - disease-level clinical article, otitis-externa-full.txt).
  • Discontinue if local irritation or sensitization occurs.
  • Avoid prolonged use (>14 days) to prevent fungal superinfection.
  • There is no miconazole-plus-hydrocortisone ear drop licensed for people anywhere - the only one is a veterinary product. Every Egyptian pack behind it is a skin cream, so it goes on the outer canal with a finger or a wick, not instilled as drops. The ciprofloxacin above it is the preparation that actually holds an ear licence.
  • Seven days is the label's ceiling, and the cream is barred from mucous membranes - keep it to the canal skin and no deeper.
  • Egypt does register a proper ear drop of this kind: clioquinol with flumethasone, sold as VIOTIC (23 EGP) and OTOCORT (26 EGP). It is licensed for the ear, which this cream is not. Whether to use it instead is a prescriber's decision - it is not listed here because no dosing label for it could be opened, and no dose is shown here that cannot be cited.
Egyptian brands
Egyptian brandManufacturerIndicative price
MONICORT CREAM 10 GMPHAROPHARMA5.25 EGP
MYKOTRAL H TOPICAL CREAM 15 GMSIGMA6.50 EGP
MYCOCORT CREAM 15 GMARAB DRUG COMPANY (ADCO)7.00 EGP
DERMOZOL CORT CREAM 15 GMPHARCO19.50 EGP
MONICORT CREAM 20 GMPHAROPHARMA23.50 EGP
DAKTACORT CREAM 15 GMMINA PHARM > JANSSEN CILAG48.00 EGP
MICONAZ-H TOPICAL EMULGEL 20 GMMUP10.00 EGP

OFLOXACIN

4

OFLOXACIN

Ofloxacin

1st line

Formear

Adult dose and duration

5 drops to the affected ear twice daily x 7 to 10 days

Paediatric dose

(From six months, for otitis externa with an intact eardrum. The ofloxacin otic label's paediatric dose, ages 6 months to 13 years, is five drops (0.25 mL, containing 0.75 mg of ofloxacin) placed in the affected ear once a day for a week. Below six months, safety and efficacy have not been established.)

Dose by age
6 months to 13 years:Five drops (0.25 mL, 0.75 mg ofloxacin) into the affected ear once daily for seven days, with an intact tympanic membrane. Not established below six months.
Dose source

Acute otitis externa - disease-level clinical article (otitis-externa-full.txt)

Why

Topical fluoroquinolone ear drops for uncomplicated acute otitis externa.

Cautions
  • Pregnancy Category C. The ofloxacin otic label restricts it in pregnancy to the case where the expected benefit is judged to outweigh the possible risk to the fetus.
Egyptian brands
Egyptian brandManufacturerIndicative price
OTOXIN 3MG/ML EAR DROPSSEDICO11.00 EGP

ANALGESIA - give alongside

5

PARACETAMOL

Analgesia

add-on - not a substitute

Strength500 mg

Formoral.solid

Adult dose and duration

1 g 3 or 4 times daily (maximum 4 g daily)

Paediatric dose

15 mg/kg/dose [child max 500 mg]

(MSF: child under 1 month, 10 mg/kg 3 or 4 times daily (max. 40 mg/kg daily); child 1 month and over, 15 mg/kg 3 or 4 times daily (max. 60 mg/kg daily).)

Dose by weight
3kg45 mg/dose
4kg60 mg/dose
5kg75 mg/dose
6kg90 mg/dose
7kg105 mg/dose
8kg120 mg/dose
9kg135 mg/dose
10kg150 mg/dose
11kg165 mg/dose
12kg180 mg/dose
13kg195 mg/dose
14kg210 mg/dose
15kg225 mg/dose
16kg240 mg/dose
17kg255 mg/dose
18kg270 mg/dose
19kg285 mg/dose
20kg300 mg/dose
21kg315 mg/dose
22kg330 mg/dose
23kg345 mg/dose
24kg360 mg/dose
25kg375 mg/dose
26kg390 mg/dose
27kg405 mg/dose
28kg420 mg/dose
29kg435 mg/dose
30kg450 mg/dose
31kg465 mg/dose
32kg480 mg/dose
33kg495 mg/dose
34kg500 mg/dose (capped)
35kg500 mg/dose (capped)
36kg500 mg/dose (capped)
37kg500 mg/dose (capped)
38kg500 mg/dose (capped)
39kg500 mg/dose (capped)
40kg500 mg/dose (capped)
41kg500 mg/dose (capped)
42kg500 mg/dose (capped)
43kg500 mg/dose (capped)
44kg500 mg/dose (capped)
45kg500 mg/dose (capped)
46kg500 mg/dose (capped)
47kg500 mg/dose (capped)
48kg500 mg/dose (capped)
49kg500 mg/dose (capped)
50kg500 mg/dose (capped)
Choice

Alternatives. The disease article offers acetaminophen or an NSAID for this pain, without ranking them. Paracetamol is named first choice because MSF contraindicates ibuprofen in peptic ulcer, asthma, renal impairment and dehydration, while paracetamol's only stated caution is hepatic impairment - so it is the safer default when the prescriber has not assessed those. Ibuprofen stays on the card.

Dose source

MSF Essential Drugs 2024 (paracetamol oral monograph)

Why

The disease article makes pain control a co-equal mainstay of treatment alongside topical antibiotics; the card carried no analgesic at all, though pain is the dominant symptom.

Cautions
  • Administer with caution to patients with hepatic impairment.
  • Do not exceed indicated doses, especially in children and older patients - paracetamol intoxications are severe (hepatic cytolysis).
  • Reduce the dose in children with severe acute malnutrition: 10 mg/kg up to 3 times maximum per 24 hours.
  • Paracetamol has no anti-inflammatory properties.
Egyptian brands
Egyptian brandManufacturerIndicative price
FEBRIMOL 500 MG 20 TAB.PHARCO3.50 EGP (0.17/unit)
CETAMOL 500 MG 20 TABS.MEMPHIS8.00 EGP (0.40/unit)
PARACETAMOL-MUP 500MG B.P. 20 TABS.MUP13.00 EGP (0.65/unit)
CETAL 500 MG 20 TABS.EIPICO24.00 EGP (1.20/unit)
ARKADOLOW 500 MG 30 F.C. TABS.UTOPIA42.00 EGP (1.40/unit)
PARAMOL 500MG 20 TAB.MISR38.00 EGP (1.90/unit)
ADOL 500MG 24 CAPLETSJULPHAR32.00 EGP
AUGICETAMIDE 500 MG 20 SACHETSAUG PHARMA50.00 EGP
FEBRIMOL ORAL DROPS 20 ML? strength differs? different route - not oral solidPHARCO4.00 EGP
THERA-LO 3.2G/100ML ORAL SUSP. 100 ML? strength differs? different route - not oral solidPHAROPHARMA5.00 EGP
6

IBUPROFEN

Analgesia

add-on - not a substitute

Strength400 mg

Formoral.solid

Adult dose and duration

200 to 400 mg 3 to 4 times daily (maximum 1,200 mg daily)

Paediatric dose

5-10 mg/kg/dose [child max 400 mg]

(MSF: child over 3 months, 5 to 10 mg/kg 3 to 4 times daily (max. 30 mg/kg daily).)

Dose by weight
3kg15-30 mg/dose
4kg20-40 mg/dose
5kg25-50 mg/dose
6kg30-60 mg/dose
7kg35-70 mg/dose
8kg40-80 mg/dose
9kg45-90 mg/dose
10kg50-100 mg/dose
11kg55-110 mg/dose
12kg60-120 mg/dose
13kg65-130 mg/dose
14kg70-140 mg/dose
15kg75-150 mg/dose
16kg80-160 mg/dose
17kg85-170 mg/dose
18kg90-180 mg/dose
19kg95-190 mg/dose
20kg100-200 mg/dose
21kg105-210 mg/dose
22kg110-220 mg/dose
23kg115-230 mg/dose
24kg120-240 mg/dose
25kg125-250 mg/dose
26kg130-260 mg/dose
27kg135-270 mg/dose
28kg140-280 mg/dose
29kg145-290 mg/dose
30kg150-300 mg/dose
31kg155-310 mg/dose
32kg160-320 mg/dose
33kg165-330 mg/dose
34kg170-340 mg/dose
35kg175-350 mg/dose
36kg180-360 mg/dose
37kg185-370 mg/dose
38kg190-380 mg/dose
39kg195-390 mg/dose
40kg200-400 mg/dose
41kg205-400 mg/dose (upper capped)
42kg210-400 mg/dose (upper capped)
43kg215-400 mg/dose (upper capped)
44kg220-400 mg/dose (upper capped)
45kg225-400 mg/dose (upper capped)
46kg230-400 mg/dose (upper capped)
47kg235-400 mg/dose (upper capped)
48kg240-400 mg/dose (upper capped)
49kg245-400 mg/dose (upper capped)
50kg250-400 mg/dose (upper capped)
Dose source

MSF Essential Drugs 2024 (ibuprofen oral monograph)

Why

Named by the disease article as the alternative to acetaminophen for mild to moderate pain in otitis externa.

Cautions
  • Do not administer to children under 3 months, patients with allergy to NSAID, peptic ulcer, coagulation defects, haemorrhage, surgery with risk of major blood loss, severe renal or hepatic impairment, severe heart failure, severe malnutrition, uncorrected dehydration or hypovolaemia, severe infection.
  • Administer with caution to elderly or asthmatic patients.
  • Do not combine with methotrexate, anticoagulants and other NSAIDs.
  • Avoid in pregnancy; ibuprofen is contraindicated from the beginning of the 6th month - use paracetamol.
Egyptian brands
Egyptian brandManufacturerIndicative price
DAJUANOFEN 400 MG 20 F.C. TABS.COPAD PHARMA5.00 EGP (0.25/unit)
FLABU 400MG 10 F.C.TAB.DELTA PHARMA3.75 EGP (0.38/unit)
NOVA-PROFEN 400MG 30 F.C. TABLETSSANOFI12.75 EGP (0.42/unit)
IBUPROFEN 400 MG 10 TAB.SEDICO6.00 EGP (0.60/unit)
MAFO 400 MG 30 F.C.TABSEIPICO42.00 EGP (1.40/unit)
BRUFEN 400 MG 30 TABS.KAHIRA > ABBOTT LABORATORIES78.00 EGP (2.60/unit)
PROFUSOL 400MG 20 S.G CAPS.EUROPEAN EGYPTIAN PHARM. IND.31.00 EGP
ANALGIPROF 400 MG 25 SACHETSEVA PHARMA37.50 EGP
NOVA-PROFEN 100MG/5ML ORAL SUSP. 100ML? strength differs? different route - not oral solidSANOFI2.25 EGP
BRUFEMOL-N SUSP. 60 ML? strength differs? different route - not oral solidARAB DRUG COMPANY (ADCO)4.50 EGP

Prices are indicative (dataset snapshot 2026-06); verify with the pharmacy.