Dexamethasone with glacial acetic acid and neomycin sulfate

How it works

Dexamethasone reduces local inflammation and oedema, glacial acetic acid lowers ear-canal pH to inhibit microbial growth, and neomycin provides bactericidal aminoglycoside cover against common otitis externa pathogens.

Prescribing in practice

• Avoid in patients with a perforated tympanic membrane because topical aminoglycosides such as neomycin carry a risk of ototoxicity when they reach the middle ear.
• Neomycin is a recognised contact sensitiser, so discontinue if signs of local hypersensitivity or worsening dermatitis develop.
• Reserve for short courses and review if the condition fails to settle, to limit sensitisation and superinfection with resistant organisms or fungi.

Monitoring

Monitor clinically for symptom resolution and for any new hearing disturbance, tinnitus or local hypersensitivity during treatment.

Counselling the patient

• Use only in the affected ear and complete the recommended short course rather than continuing indefinitely.
• Stop and seek advice if you develop dizziness, ringing in the ears, hearing changes or a rash.
• Tell the clinician if you think your eardrum may be perforated.

Evidence & guidelines

Topical antibiotic-corticosteroid drops are an established first-line treatment for acute otitis externa, consistent with NICE and UK ENT guidance.