Eyes, ears, nose and throat infections + dental infections

Otitis media, otitis externa (swimmer's ear), strep throat, conjunctivitris dental abscesse

What is otitis media?

Acute otitis media is inflammation in the middle ear associated with effusion and accompanied by an ear infection.

What is the treatment for otitis media? Give first and second line + with or without penicillin allergy.

If no penicillin allergy:

• First line: amoxicillin.

• Second line: co-amoxiclav

Penicillin allergy or intolerance

• First line: clarithromycin or erythromycin (in pregnancy).

• Second line: consult local microbiologist.

What can be offered if antibiotic treatment for otitis media is not indicated?

Consider offering an ear drop containing an anaesthetic and an analgesic such as phenazone with lidocaine, if immediate antibacterial treatment is not given and there is no eardrum perforation or otorrhoea.

Paracetamol or ibuprofen

What is otitis externa?

Otitis externa is inflammation of the external ear canal.

How do you treat acute otitis externa?

Topical acetic acid 2% - acts as an astringent reducing the pH and reducing bacterial and fungal cell growth

How do you treat chronic otitis externa? Consider if fungal, bacterial or neither?

Fungal: topical antifungal (clotrimazole 1% solution), acetic acid 2% spray, clioquinol + corticosteroid drops,

Bacterial: gentamicin or ciprofloxacin ear drops or systemic flucloxacillin

Neither: prednisolone ear drops

What type of bacteria causes Strep throat and Scarlett fever?

Both infection are part of the Streptococcus bacteria family.

What is first line treatment for Strep throat and Scarlett fever?

First line: phenoxymethylpenicillin

What is second line treatment for Strep throat?

Clarithromycin

What is second line treatment for Scarlett fever?

Second-line options for people with penicillin allergy:

Clarithromycin, azithromycin or erythromycin (if pregnant or postpartum)

What are the typical symptoms of Scarlett fever?

• Flu like symptoms

• Fever

• Sore throat and/or swollen neck glands

• Red, blanching rash on chest and stomach before spreading to the rest of the body within 48 hours

  • Small raised bumps

  • Sandpaper like texture

  • Palms and soles are typically spared

• Strawberry tongue

  • Initial white coating on tongue with enlarged papillae which peels a few days later, leaving the tongue looking red and swollen

What is first and second line treatments for dental abscesses?

First line: amoxicillin or phenoxymethylpenicillin

Second line: metronidazole or clarithromycin

How do you treat conjunctivitis?

Chloramphenicol 0.5% eye drops: 1 drop 2 hourly for 48 hours, then 3-4 times daily thereafter

Chloramphenicol 1% eye ointment: apply 3-4 times daily

Fusidic acid 1% eye drops: apply 1 drop twice daily

Continue until 48 hours after infection has clears.

What patient groups can you not treat conjunctivitis over the counter?

Pregnant women and children under 2 years