{ "schema_version": 1, "kind": "condition", "id": "otitis-externa", "name": "Acute otitis externa", "category": "infectious", "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)", "review_status": "reviewed", "verified_against": "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_date": "2026-08", "treatments": [ { "id": 1321, "generic": "Ciprofloxacin", "line": 1, "is_adjunct": false, "form": "ear", "strength_mg": null, "adult_dose": "Instill 3-4 drops into affected ear twice daily", "adult_duration": "7 days", "dose_source": "Egyptian National Drug Formulary - Antimicrobial 2023", "rationale": "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)." ], "peds_mgkg_low": null, "peds_mgkg_high": null, "peds_max_mg": null, "peds_basis": null, "peds_unit": null, "peds_note": "Children >1 year: 3 drops twice daily into affected ear for 7 days", "peds_min_weight_kg": null, "peds_max_weight_kg": null, "peds_age_min_months": null, "peds_age_max_months": null, "peds_age_bands": [ { "label": "Over 1 year", "age_min_months": 13, "age_max_months": 216, "dose_text": "3 drops twice daily into affected ear for 7 days" } ], "peds_doses": null, "brands": [ { "trade_name": "CIPRO 0.3% EAR DROPS 10 ML", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "CID", "price_egp": 15.0, "pack_count": null, "unit_price": null, "strength_mg": null, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null } ], "condition_id": "otitis-externa" }, { "id": 1323, "generic": "Referral & safety-netting (no drug therapy)", "line": 1, "is_adjunct": false, "form": null, "strength_mg": null, "adult_dose": null, "adult_duration": null, "dose_source": "Otitis Externa - disease-level clinical article (otitis-externa-full.txt)", "rationale": "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." ], "peds_mgkg_low": null, "peds_mgkg_high": null, "peds_max_mg": null, "peds_basis": null, "peds_unit": null, "peds_note": null, "peds_min_weight_kg": null, "peds_max_weight_kg": null, "peds_age_min_months": null, "peds_age_max_months": null, "peds_age_bands": null, "peds_doses": null, "brands": [], "condition_id": "otitis-externa" }, { "id": 1324, "generic": "Ofloxacin", "line": 1, "is_adjunct": false, "form": "ear", "strength_mg": null, "adult_dose": "5 drops to the affected ear twice daily", "adult_duration": "7 to 10 days", "dose_source": "Acute otitis externa - disease-level clinical article (otitis-externa-full.txt)", "rationale": "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." ], "peds_mgkg_low": null, "peds_mgkg_high": null, "peds_max_mg": null, "peds_basis": null, "peds_unit": null, "peds_note": "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.", "peds_min_weight_kg": null, "peds_max_weight_kg": null, "peds_age_min_months": null, "peds_age_max_months": null, "peds_age_bands": [ { "label": "6 months to 13 years", "age_min_months": 6, "age_max_months": 167, "dose_text": "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." } ], "peds_doses": null, "brands": [ { "trade_name": "OTOXIN 3MG/ML EAR DROPS", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "SEDICO", "price_egp": 11.0, "pack_count": null, "unit_price": null, "strength_mg": 3.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null } ], "condition_id": "otitis-externa" }, { "id": 1322, "generic": "Hydrocortisone + Miconazole", "line": 2, "is_adjunct": false, "form": "topical", "strength_mg": null, "adult_dose": "Apply the cream thinly to the outer ear canal twice daily", "adult_duration": "7 days maximum", "dose_source": "Daktacort (miconazole 2% + hydrocortisone 1%) cream SmPC sections 4.1-4.2 (eMC product 1557)", "rationale": "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." ], "peds_mgkg_low": null, "peds_mgkg_high": null, "peds_max_mg": null, "peds_basis": null, "peds_unit": null, "peds_note": "Over 2 years: apply thinly to the outer canal twice daily, 7 days at most.", "peds_min_weight_kg": null, "peds_max_weight_kg": null, "peds_age_min_months": null, "peds_age_max_months": null, "peds_age_bands": [ { "label": "Over 2 years", "age_min_months": 24, "age_max_months": 216, "dose_text": "Apply thinly to the outer canal twice daily, for 7 days at most" } ], "peds_doses": null, "brands": [ { "trade_name": "MONICORT CREAM 10 GM", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "PHAROPHARMA", "price_egp": 5.25, "pack_count": null, "unit_price": null, "strength_mg": 10000.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "MYKOTRAL H TOPICAL CREAM 15 GM", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "SIGMA", "price_egp": 6.5, "pack_count": null, "unit_price": null, "strength_mg": 15000.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "MYCOCORT CREAM 15 GM", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "ARAB DRUG COMPANY (ADCO)", "price_egp": 7.0, "pack_count": null, "unit_price": null, "strength_mg": 15000.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "DERMOZOL CORT CREAM 15 GM", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "PHARCO", "price_egp": 19.5, "pack_count": null, "unit_price": null, "strength_mg": 15000.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "MONICORT CREAM 20 GM", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "PHAROPHARMA", "price_egp": 23.5, "pack_count": null, "unit_price": null, "strength_mg": 20000.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "DAKTACORT CREAM 15 GM", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "MINA PHARM > JANSSEN CILAG", "price_egp": 48.0, "pack_count": null, "unit_price": null, "strength_mg": 15000.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "MICONAZ-H TOPICAL EMULGEL 20 GM", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "MUP", "price_egp": 10.0, "pack_count": null, "unit_price": null, "strength_mg": 20000.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null } ], "condition_id": "otitis-externa" }, { "id": 1325, "generic": "Paracetamol", "line": 1, "is_adjunct": true, "form": "oral.solid", "strength_mg": 500.0, "adult_dose": "1 g 3 or 4 times daily (maximum 4 g daily)", "adult_duration": null, "dose_source": "MSF Essential Drugs 2024 (paracetamol oral monograph)", "rationale": "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." ], "peds_mgkg_low": 15.0, "peds_mgkg_high": 15.0, "peds_max_mg": 500.0, "peds_basis": "dose", "peds_unit": "mg", "peds_note": "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).", "peds_min_weight_kg": null, "peds_max_weight_kg": null, "peds_age_min_months": null, "peds_age_max_months": null, "peds_age_bands": null, "peds_doses": [ { "weight_kg": 10, "low_mg": 150, "high_mg": 150, "capped": false }, { "weight_kg": 20, "low_mg": 300, "high_mg": 300, "capped": false }, { "weight_kg": 30, "low_mg": 450, "high_mg": 450, "capped": false }, { "weight_kg": 40, "low_mg": 500, "high_mg": 500, "capped": true } ], "brands": [ { "trade_name": "FEBRIMOL 500 MG 20 TAB.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "PHARCO", "price_egp": 3.5, "pack_count": 20, "unit_price": 0.17, "strength_mg": 500.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "CETAMOL 500 MG 20 TABS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "MEMPHIS", "price_egp": 8.0, "pack_count": 20, "unit_price": 0.4, "strength_mg": 500.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "PARACETAMOL-MUP 500MG B.P. 20 TABS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "MUP", "price_egp": 13.0, "pack_count": 20, "unit_price": 0.65, "strength_mg": 500.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "CETAL 500 MG 20 TABS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "EIPICO", "price_egp": 24.0, "pack_count": 20, "unit_price": 1.2, "strength_mg": 500.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "ARKADOLOW 500 MG 30 F.C. TABS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "UTOPIA", "price_egp": 42.0, "pack_count": 30, "unit_price": 1.4, "strength_mg": 500.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "PARAMOL 500MG 20 TAB.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "MISR", "price_egp": 38.0, "pack_count": 20, "unit_price": 1.9, "strength_mg": 500.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "ADOL 500MG 24 CAPLETS", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "JULPHAR", "price_egp": 32.0, "pack_count": null, "unit_price": null, "strength_mg": 500.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "AUGICETAMIDE 500 MG 20 SACHETS", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "AUG PHARMA", "price_egp": 50.0, "pack_count": null, "unit_price": null, "strength_mg": 500.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "FEBRIMOL ORAL DROPS 20 ML", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "PHARCO", "price_egp": 4.0, "pack_count": null, "unit_price": null, "strength_mg": null, "exact_strength": false, "exact_form": false, "discontinued": false, "also_contains": null }, { "trade_name": "THERA-LO 3.2G/100ML ORAL SUSP. 100 ML", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "PHAROPHARMA", "price_egp": 5.0, "pack_count": null, "unit_price": null, "strength_mg": 3200.0, "exact_strength": false, "exact_form": false, "discontinued": false, "also_contains": null } ], "condition_id": "otitis-externa" }, { "id": 1326, "generic": "Ibuprofen", "line": 1, "is_adjunct": true, "form": "oral.solid", "strength_mg": 400.0, "adult_dose": "200 to 400 mg 3 to 4 times daily (maximum 1,200 mg daily)", "adult_duration": null, "dose_source": "MSF Essential Drugs 2024 (ibuprofen oral monograph)", "rationale": "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." ], "peds_mgkg_low": 5.0, "peds_mgkg_high": 10.0, "peds_max_mg": 400.0, "peds_basis": "dose", "peds_unit": "mg", "peds_note": "MSF: child over 3 months, 5 to 10 mg/kg 3 to 4 times daily (max. 30 mg/kg daily).", "peds_min_weight_kg": null, "peds_max_weight_kg": null, "peds_age_min_months": null, "peds_age_max_months": null, "peds_age_bands": null, "peds_doses": [ { "weight_kg": 10, "low_mg": 50, "high_mg": 100, "capped": false }, { "weight_kg": 20, "low_mg": 100, "high_mg": 200, "capped": false }, { "weight_kg": 30, "low_mg": 150, "high_mg": 300, "capped": false }, { "weight_kg": 40, "low_mg": 200, "high_mg": 400, "capped": false } ], "brands": [ { "trade_name": "DAJUANOFEN 400 MG 20 F.C. TABS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "COPAD PHARMA", "price_egp": 5.0, "pack_count": 20, "unit_price": 0.25, "strength_mg": 400.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "FLABU 400MG 10 F.C.TAB.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "DELTA PHARMA", "price_egp": 3.75, "pack_count": 10, "unit_price": 0.38, "strength_mg": 400.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "NOVA-PROFEN 400MG 30 F.C. TABLETS", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "SANOFI", "price_egp": 12.75, "pack_count": 30, "unit_price": 0.42, "strength_mg": 400.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "IBUPROFEN 400 MG 10 TAB.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "SEDICO", "price_egp": 6.0, "pack_count": 10, "unit_price": 0.6, "strength_mg": 400.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "MAFO 400 MG 30 F.C.TABS", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "EIPICO", "price_egp": 42.0, "pack_count": 30, "unit_price": 1.4, "strength_mg": 400.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "BRUFEN 400 MG 30 TABS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "KAHIRA > ABBOTT LABORATORIES", "price_egp": 78.0, "pack_count": 30, "unit_price": 2.6, "strength_mg": 400.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "PROFUSOL 400MG 20 S.G CAPS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "EUROPEAN EGYPTIAN PHARM. IND.", "price_egp": 31.0, "pack_count": null, "unit_price": null, "strength_mg": 400.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "ANALGIPROF 400 MG 25 SACHETS", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "EVA PHARMA", "price_egp": 37.5, "pack_count": null, "unit_price": null, "strength_mg": 400.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "NOVA-PROFEN 100MG/5ML ORAL SUSP. 100ML", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "SANOFI", "price_egp": 2.25, "pack_count": null, "unit_price": null, "strength_mg": 100.0, "exact_strength": false, "exact_form": false, "discontinued": false, "also_contains": null }, { "trade_name": "BRUFEMOL-N SUSP. 60 ML", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "ARAB DRUG COMPANY (ADCO)", "price_egp": 4.5, "pack_count": null, "unit_price": null, "strength_mg": null, "exact_strength": false, "exact_form": false, "discontinued": false, "also_contains": null } ], "condition_id": "otitis-externa" } ] }