(e) ENT

Tonsillitis/pharyngitis:
First Choice:
no antibiotic treatment (majority resolve in 7 days)
Second Choice:
penicillin V (clarithromycin if penicillin allergic) for 10 days treatment
Otitis externa:
First Choice:
ear toilet and analgesia 
Second Choice:
Otomize ® ear spray 3 times daily (if the ear–drum is not perforated)
Otitis media:
First Choice:
no antibiotic treatment
Second Choice:
amoxicillin (clarithromycin if penicillin allergic) for 5 days
Oral thrush:
First Choice:
nystatin
Second Choice:
miconazole
Dental abscess and Gingivitis:
See Scottish Dental Clinical Effectiveness Programme: Drug Prescribing for Dentistry.
Formulations/Dose
  • amoxicillin capsules 250mg, 500mg; oral suspension 125mg/5mL, 250mg/5mL.
    • 1 month - 18 years, 40mg/kg (max 1.5g) in 3 divided doses
    • A 5–day course should be given for otitis media.
  • clarithromycin tablets 250mg, 500mg; suspension 125mg/5mL, 250mg/5mL.
    • 1month – 12 years
      <8kg body weight, 7.5mg/kg twice daily
      8-11kg body weight, 62.5mg twice daily
      12-19kg body weight, 125mg twice daily
      20-29kg body weight, 187.5mg twice daily
      30-40kg body weight, 250mg twice daily, increased if necessary in severe infections to 500mg twice daily
    • 12 – 18 years, 250mg twice daily, increased if necessary in severe infections to 500mg twice daily
  • miconazole oral gel 20mg/1g
    Not licensed for use in children under 4 months
    or during first 5 - 6 months of life in an infant born pre-term.
    • 1 month – 2 years, 2.5mL twice a day.
    • 2 – 6 years, 5mL twice a day.
    • 6 – 12 years, 5mL four times a day.
    • 12 – 18 years, 5–10mL four times a day.
      Use in the mouth after food or feeds and retain as long as possible before swallowing. For localised lesions, apply directly to affected area. Continue for at least 48 hours after lesions heal.
    Miconazole oral gel is indicated in the treatment of oral thrush in breastfed infants (including babies under 4 months of age). This use has been approved by the Lothian Neonatal and Paediatric Drug and Therapeutics Committee; 1mL portion divided into four parts and smeared around mouth using clean finger four times daily after feeds for at least 10 days, continue for 7 days after improvement noted.
  • nystatin oral suspension 100,000units/mL (30mL)
    • All ages, 1mL four times a day.
      Continue for at least 48 hours after lesions heal.
  • penicillin V tablets 250mg; oral solution 125mg/5mL, 250mg/5mL.
    • 1 month - 1 year, 62.5mg four times a day.
    • 1 – 6 years, 125mg four times a day.
    • 6 – 12 years 250mg four times a day.
    • 12 – 18 years 500mg four times a day.
      Usual length of course for Streptococcal A infection is 10 days.
Prescribing Notes

Dental abscess and Gingivitis

Sore throat/tonsillitis/pharyngitis

  • The majority of sore throats are viral and self–limiting. Streptococcal A infection requires 10 day treatment. There is little evidence of benefit from prescribing antibiotics unless any of the following are present: systemic toxicity, recurrent tonsillitis, immunocompromised, debilitated or prolonged (more than 7 days) illness. Since the reconstituted expiry date of penicillin V suspension is 7 days, 2 bottles of suspension should be prescribed to be dispensed a week apart.
  • Consider glandular fever if sore throat persists or patient is debilitated and not responding to antibiotics.

Otitis externa

  • See section 12.1.1.
  • Many cases respond to ear toilet alone, with or without the addition of astringent drops.
  • In recurrent or persistent otitis externa, send a swab; recurrent cases may be due to fungal or pseudomonas infection when advice an alternative treatment should be sought.

Otitis media

  • Antibiotics do not reduce pain in the first 24 hours, and make no difference to the likelihood of a further infection or hearing difficulty.
  • Consider antibiotics if any of the following are present: systemic toxicity, recurrent ear infection, immunocompromised, debilitated or prolonged illness (more than 2–3 days). In other cases consider withholding prescription or give delayed prescription.
  • Erythromycin is not indicated for otitis media because it is not effective against Haemophilus influenzae; clarithromycin is the drug of choice for penicillin allergic patients.