Corticosteroid + aminoglycoside + polypeptide antibiotic

Dexamethasone with framycetin sulfate and gramicidin

Brand names: Sofradex

Adult dose

Dose: Ear: 2–3 drops TDS–QDS; Eye: 1–2 drops 4–6× daily

Route: Otic / Ophthalmic

Frequency: TDS–QDS

Clinical pearls

NICE CKS Otitis externa: topical antibiotic + steroid first-line for acute OE
ENT UK guidance — short courses (≤7 days) and review
Avoid extended use (>7–14 days) due to sensitisation/superinfection

Contraindications

Perforated tympanic membrane (ototoxicity risk — relative)
Viral, fungal or tuberculous infection
Aminoglycoside hypersensitivity
Glaucoma (chronic eye use)

Side effects

Local irritation
Hypersensitivity
Ototoxicity (perforated drum)
Increased IOP / cataract (chronic eye use)
Superinfection

Interactions

Other ototoxic drugs

Monitoring

Symptom resolution
Ear examination if no response by 7 days
IOP if extended ophthalmic use

Reference: BNF; NICE CKS Otitis externa; ENT UK; https://bnf.nice.org.uk/drugs/dexamethasone-with-framycetin-sulfate-and-gramicidin/. Verify against your local formulary and the latest BNF before prescribing.

Curated clinical cross-links plus same-class fallbacks.

Calculators

Pathways