Dexamethasone with framycetin sulfate and gramicidin

How it works

Dexamethasone provides local anti-inflammatory action while framycetin (an aminoglycoside) and gramicidin provide antibacterial cover against common susceptible organisms at the site of application.

Prescribing in practice

• Because the framycetin component is potentially ototoxic, aural use should generally be avoided when the tympanic membrane is perforated, as access to the middle ear risks ototoxic cochlear damage.
• Treatment should be short-term; prolonged use risks local antibiotic resistance, fungal superinfection and, with ocular use, corticosteroid-related rises in intraocular pressure.
• It is contraindicated where the eye or ear infection is viral or fungal, as the steroid component may worsen these.

Monitoring

Review response over a short course and reassess if symptoms persist; with ocular use consider intraocular pressure on prolonged treatment.

Counselling the patient

• Use only for the short course prescribed and do not continue long-term.
• Tell the prescriber if you have a known hole in the eardrum or previous ear surgery.
• Seek review if symptoms do not improve within a few days.

Evidence & guidelines

Combined topical corticosteroid-aminoglycoside ear and eye preparations are established treatments for infected inflammatory otitis externa and selected ocular conditions, with avoidance advised where the eardrum is perforated.