{
  "schema_version": 1,
  "kind": "condition",
  "id": "otorrhoea",
  "name": "Ear discharge (otorrhoea)",
  "category": "infectious",
  "sources": "Egyptian National Drug Formulary - Antimicrobial 2023 · No dose - assessment step, no medicine given · Medina-Blasini Y, Sharman T. Otitis Externa. [Updated 2023 Jul 31]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2026 Jan-. Bookshelf ID: NBK556055; PMID: 32310515.",
  "review_status": "reviewed",
  "verified_against": "Egyptian National Drug Formulary - Antimicrobial 2023 · No dose - assessment step, no medicine given · Medina-Blasini Y, Sharman T. Otitis Externa. [Updated 2023 Jul 31]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2026 Jan-. Bookshelf ID: NBK556055; PMID: 32310515.",
  "verified_date": "2026-08",
  "treatments": [
    {
      "id": 1329,
      "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": "A discharging ear means the eardrum is perforated until proved otherwise, so the drop has to be safe behind a perforation. Ciprofloxacin is non-ototoxic and covers the Pseudomonas and staphylococci that cause it. That safety, not the spectrum, is the reason it is first choice.",
      "cautions": [
        "Do NOT use aminoglycoside ear drops - gentamicin, neomycin, framycetin - when the drum may be perforated. They can cause permanent, irreversible deafness, and a discharging ear is a perforated ear until you have seen otherwise.",
        "Clean debris from ear canal prior to instillation.",
        "Keep ear canal dry during treatment.",
        "Foul-smelling discharge, a retraction pocket, or granulation tissue at the drum edge suggests cholesteatoma. That is a surgical problem - refer to ENT rather than repeating drops.",
        "Discharge with facial weakness, vertigo, severe pain, or swelling and tenderness behind the ear is mastoiditis or an intracranial complication - same-day referral.",
        "Discharge that will not stop after two proper courses, or that returns as soon as treatment ends, needs ENT assessment and a swab.",
        "Egypt also registers OTOXIN 3 mg/mL ofloxacin ear drops (11 EGP), equally non-ototoxic and a reasonable alternative. It is not listed as its own option because no dosing label for it could be opened, and no dose is shown here that cannot be cited.",
        "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": "otorrhoea"
    },
    {
      "id": 1330,
      "generic": "No drug therapy in primary care (Assess first)",
      "line": 1,
      "is_adjunct": false,
      "form": null,
      "strength_mg": null,
      "adult_dose": "Before treating, work out where the discharge is coming from. Otitis externa gives a tender, swollen, itchy canal and pain on pulling the pinna. Discharge through a perforation or a grommet comes from the middle ear and often follows an acute otitis media that has just burst, with the pain suddenly relieved. Wax, a foreign body and blood after trauma are the other things in the canal.",
      "adult_duration": "Assess, then decide",
      "dose_source": "No dose - assessment step, no medicine given",
      "rationale": "The choice of drop and the decision to refer both hang on whether the drum is intact, and that single question is what makes the difference between a safe drop and a deafening one.",
      "cautions": [
        "Blood or clear fluid from the ear after a head injury may be cerebrospinal fluid. Do not instil anything - refer immediately.",
        "In a diabetic or immunocompromised patient with severe pain, granulation in the canal floor and discharge, consider necrotising (malignant) otitis externa. That is an emergency admission, not a drop.",
        "Syringing an ear that is discharging, or that may be perforated, is not safe."
      ],
      "peds_mgkg_low": null,
      "peds_mgkg_high": null,
      "peds_max_mg": null,
      "peds_basis": null,
      "peds_unit": null,
      "peds_note": "A unilateral foul discharge in a child with no pain is a foreign body in the canal until proved otherwise - look. Discharge through a grommet is common and is usually treated with the same quinolone drop.",
      "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": "otorrhoea"
    }
  ]
}