Topical otic antibiotic + corticosteroid Pregnancy: Safety in pregnancy has not been established; topical administration of any corticosteroid to pregnant animals can cause abnormalities of foetal development. Use in pregnancy only when considered essential by the physician after careful assessment of risks and benefits. Safety in lactation has not been established — same restriction applies. No fertility data available.

Gentamicin with hydrocortisone

Brand names: Gentisone HC

Used in: Acute Appendicitis

A compound topical preparation combining the aminoglycoside antibiotic gentamicin with the corticosteroid hydrocortisone, used for infected inflammatory ear (and eye) conditions such as otitis externa.

Auto-extracted from the source labelling — not yet independently clinician-verified. These values were distilled from the UK SPC (or the US label where noted) but have not had a clinician sign-off. Confirm against the current SmPC before prescribing.

Adult dose

Dose: The area should be cleaned and 2–4 drops instilled in the affected ear three to four times a day and at night. Alternatively, wicks medicated with this medicine may be placed in the external ear or mastoid cavity

Route: Auricular use only (SPC product = Gentisone HC, gentamicin 0.3% w/v and hydrocortisone acetate 1% w/v ear drops)

Frequency: Three to four times a day and at night

The SPC gives the same posology for adults, the elderly and the paediatric population — no per-kg dose is stated. Long-term continuous topical therapy should be avoided; prolonged use may lead to skin sensitisation and emergence of resistant organisms. Cross-sensitivity with other aminoglycoside antibiotics may occur. In severe infections, topical use should be supplemented with appropriate systemic antibiotic treatment. The condition of the ear drum must always be checked before prescribing and the product must not be used if the integrity of the ear drum cannot be guaranteed — irreversible toxic effects may result from direct contact of gentamicin with the middle and inner ear. Ototoxicity risk is dose-related, enhanced by renal and/or hepatic impairment and more likely in the elderly; increased risk in patients with mitochondrial mutations, particularly m.1555A>G. Contains benzalkonium chloride, which may irritate the skin. Paediatric: in infants there is a theoretical risk that sufficient steroid may be absorbed to cause adrenal suppression.

Dose auto-extracted from UK Summary of Product Characteristics (SPC) via the eMC; US FDA prescribing information (openFDA / DailyMed) — cross-check; US labelling may differ from UK — not yet clinician-verified. Always confirm against the product SmPC and your local formulary before prescribing.

Contraindications

Hypersensitivity to the active substance or to any of the excipients
Myasthenia gravis
Known or suspected perforation of the ear drum

Side effects

Local sensitivity (frequency not known)
Ototoxicity, vestibular disorder, hearing loss (frequency not known)
Burning sensation, stinging (frequency not known)
Itching (pruritus), dermatitis (frequency not known)
Blurred vision (frequency not known)

Interactions

§4.5: none relevant to topical use
Co-treatment with CYP3A inhibitors, including cobicistat-containing products, is expected to increase the risk of systemic corticosteroid side-effects — avoid unless the benefit outweighs the risk, in which case monitor for systemic corticosteroid side-effects (§4.4)
Concomitant systemic aminoglycosides — caution advised (neurotoxicity, ototoxicity and nephrotoxicity have occurred with systemic gentamicin) (§4.4)

Clinical monograph

How it works

Gentamicin is a bactericidal aminoglycoside active against common Gram-negative and other ear pathogens, while hydrocortisone provides local anti-inflammatory corticosteroid effect to reduce swelling and irritation.

Prescribing in practice

Avoid instilling into the ear when the tympanic membrane is perforated because topical gentamicin can cause ototoxicity if it reaches the middle ear.
Aminoglycosides can cause local hypersensitivity, so discontinue if signs of sensitisation appear.
Limit to short courses and reassess if there is no improvement, to reduce resistance and fungal superinfection.

Monitoring

Monitor for symptom resolution and for any new hearing disturbance or local hypersensitivity reaction during treatment.

Counselling the patient

Use only in the affected ear and complete the short course as directed.
Stop and seek advice if you develop dizziness, hearing changes, tinnitus or a rash.
Tell the clinician if you think your eardrum is perforated.

Evidence & guidelines

Topical aminoglycoside-corticosteroid combinations are established for infected otitis externa, with perforation a key contraindication per UK prescribing references.

Reference: Drug verified in RxNorm (NLM); confirm dosing against the manufacturer SPC (eMC). Verify against your local formulary and current prescribing references before prescribing. The structured dose values shown have been reviewed by a clinician. Monograph status: clinician-reviewed (2026-07-04).

Curated clinical cross-links plus same-class fallbacks.

Calculators

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