Framycetin / Sofradex

How it works

Framycetin and gramicidin act as topical antibacterial agents against common ear pathogens, while the dexamethasone component in Sofradex reduces local inflammation and oedema.

Prescribing in practice

• Avoid use when the tympanic membrane is perforated, as the aminoglycoside framycetin can cause ototoxicity if it reaches the middle ear.
• Aminoglycosides such as framycetin can cause local hypersensitivity and contact sensitisation, so discontinue if local reactions develop.
• Limit to short courses and review if symptoms persist to reduce sensitisation and the risk of fungal or resistant superinfection.

Monitoring

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

Counselling the patient

• Use only in the affected ear and for the short course advised.
• Stop and seek advice if you notice dizziness, hearing changes, ringing in the ears or a rash.
• Let the clinician know if your eardrum may be perforated.

Evidence & guidelines

Topical antibiotic-corticosteroid ear preparations are an established treatment for otitis externa, used cautiously in the presence of a perforated eardrum per UK ENT guidance.