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 Formulary Chapter 12: Ear, nose and oropharynx - Full Chapter
12.01  Drugs acting on the ear
 note 

Some ear conditions can be self managed and where appropriate patients should be encourage to buy products that are available over the counter.

Items are indicated as such in individual monographs.

Pharmacy First options should also be utilised.

12.01.01  Otitis externa
12.01.01  Anti-inflammatory preparations
Betamethasone ear drops
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Formulary
Green
 
Prednisolone ear drops
(Predsol®)
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Formulary
Green
 
12.01.01  Anti-infective preparations
Dexamethasone with Antibacterial
(Otomize®)
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First Choice
Green
 
Clotrimazole
(Liquid)
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First Choice
Green
 
Ciprofloxacin 3mg/ml with dexamethasone 1mg/ml
(Cilodex®)
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Formulary
Green
 
Dexamethasone with Antibacterials (ear)
(Sofradex®)
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Green

Use clotrimazole if fungal infection suspected

 
Flumetasone 0.02% with Clioquinol 1%
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Green
 
Hydrocortisone Acetate 1% with Gentamicin 0.3%
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Green
 
Hydrocortisone with Antibactrial
(Otosporin®)
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Formulary
Green
 
12.01.02  Otitis media to top
 note 

As per Antibiotic guidelines:

Usually resolves within 24h without antibiotics in 60% of cases.

Optimise pain relief

Average length of illness is 4 days

 

12.01.03  Removal of ear wax
 note 

This can be self managed.

OTC products available and Olive oil and Sodium Bicarbonate are available on Pharmacy First scheme

Olive Oil Ear Drops
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First Choice
Green

Available OTC

Encourage self care

Pharmacy First

 

 
Cerumol ®
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Second Choice
Green

Contains Arachis oil - Peanut allergy

Available OTC - encourage self care

 
Sodium Bicarbonate
(ear drops)
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Second Choice
Green

Available OTC

Encourage self care

Pharmacy First

 
Urea Hydrogen peroxide
(Exterol ® Otex®)
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Second Choice
Green

Available OTC

Encourage Self Care

 
Acetic Acid 2%
(Earcalm ®)
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Third Choice
Green

EarCalm should be used for keratin debris removal

Available OTC

Encourage self care

 
12.02  Drugs acting on the nose
12.02.01  Drugs used in nasal allergy
 note 

Most products can be self managed especially if a seasonal allergy.

Patients should be advised that it can take several days for the response to be noticeable. Failure of treatement should only be attributed after a reasonable length of time. Before changing to second option check technique.

OTC formulations are available for Beclomethasone and Fluticasone propionate nasal sprays.

Belcomethasone and mometasone are considered joint preferred first choice. The one should be tried following failure on other.

Fluticasone is third line and used for treatment of nasal polyps. Fluticasone Furoate (Avamys) offers a cost effective fluticasone option to fluticasone proprionate.

Fluticasone formulations offer a better licensed age range.

 

25% glucose with glycerine nasal drops
(Glycerdex®)
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Formulary
Yellow

For atrophic rhinitis type symptoms

 

 
12.02.01  Antihistamines
 note 

See Chapter 3 Respiratory for antihistamine choices and advice

12.02.01  Corticosteroids to top
Beclometasone Dipropionate
(Nasal spray)
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First Choice
Green
 
Mometasone Furoate
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First Choice
Green
 
Fluticasone furoate
(Avamys®)
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Third Choice
Green
 
Fluticasone Propionate
(Nasal Spray)
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Fourth Choice
Green
 
Betamethasone nasal drops
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Formulary
Green

Licensed for non-infected inflamatory nasal conditions.

 
Fluticasone Propionate
(Flixonase Nasule®)
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Red

Licensed for use with Nasal Polyps

Review if no improvement after 4-6 weeks

 
12.02.02  Topical nasal decongestants
 note 

Ephedrine and xylometazoline may cause rebound congestion on withdrawal or with prolonged use.

Do not use for more than seven days in the case of ephedrine and fourteen days in the case of xylometazoline.

Use of oral decongestants is not recommended

Sodium chloride 0.9%
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First Choice
Green

Available OTC

Pharmacy First

 
Ephedrine
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Second Choice
Green

Avaialble OTC

0.5% and 1% nasal drops

0.1% Spray

 
Sterimar®
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Third Choice
Green

Available OTC

 
12.02.03  Nasal preparations for infection
12.02.03  Nasal Staphylococci
Chlorhexidine Hydrochloride 0.1%, Neomycin Suphate 0.5%
(Naseptin®)
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First Choice
Green
 
Mupirocin 2%
(Bactroban Nasal®)
(nasal)
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Second Choice
Green

For MRSA only

 
12.03  Drugs acting on the oropharynx
12.03.01  Drugs for oral ulceration and inflammation to top
Benzydamine (Difflam®)
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Formulary
Green
 
Choline Salicylate
(Bonjela® Adult)
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Formulary
Green
 
Caphosol ®
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Formulary
Green plus

Chemotherapy mouthcare

Usually issued via hospital but supplies may be requested in primary care for certain circumstances.

 
Gelclair ®
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Formulary
Green plus

Chemotherapy mouthcare

Usually issued via hospital but supplies may be requested in primary care for certain circumstances.

 
Glycerol dioleate (Episil®)
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Formulary
Green plus

Chemotherapy mouthcare

Usually issued via hospital but supplies may be requested in primary care for certain circumstances.

 
Hydrocortisone
(muco-adhesive buccal tablets )
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Formulary
Green

For mouth ulcers

 
Antacid with Oxetacaine
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Formulary
Yellow

UNLICENSED SPECIAL in primary care.

 
12.03.02  Oropharyngeal Fungal infections
Nystatin (Nystan®)
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First Choice
Green
 
Miconazole (Daktarin®)
(Oral gel)
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Second Choice
Green
 
12.03.02  Oropharyngeal Viral infections
12.03.04  Mouthwashes, gargles, and dentifrices
Chlorhexidine mouthwash
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First Choice
Green
 
12.03.05  Treatment of dry mouth
 note 

Consider anticholinergic burden as a cause of dry mouth

12.03.05  Local Treatment to top
AS saliva Orthana ®
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Formulary
Green
 
Saliveze ®
(Oral spray)
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Formulary
Green
 
Salivix ®
(Pastilles)
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Green
 
 ....
Key
note Notes
Section Title Section Title (top level)
Section Title Section Title (sub level)
First Choice Item First Choice item
Non Formulary Item Non Formulary section
Restricted Drug
Restricted Drug
Unlicensed Drug
Unlicensed
Track Changes
Display tracking information
click to search medicines.org.uk
Link to adult BNF
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Link to children's BNF
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Link to SPCs
SMC
Scottish Medicines Consortium
Cytotoxic Drug
Cytotoxic Drug
CD
Controlled Drug
High Cost Medicine
High Cost Medicine
Cancer Drugs Fund
Cancer Drugs Fund
NHSE
NHS England
Homecare
Homecare
CCG
CCG

Traffic Light Status Information

Status Description

Green

Drugs that may be initiated, stabilised and maintained by primary, secondary or tertiary care Secondary and tertiary care prescribing may be continued by primary care. [this does not indicate first/second line choice]  

Green Hospital

Items used by the Hospital but would not normally be continued into primary care. Primary care prescribers can change to GREEN first or second.   

Green plus

Initiation of drugs by primary care following written advice from secondary/ tertiary care advice.  

Yellow

Drugs that may be continued in primary care following initiation and stabilisation in secondary/tertiary care  

Amber

Items requiring a shared care agreement. These items should be initiated and stabilised by secondary or tertiary care. The GP should only be asked to take over prescribing through a formal shared care agreement. Secondary care will be expected to continue prescribing until the agreement is made.  

Red

Hospital/ Trust ONLY. These are items the secondary and tertiary care are responsible for prescribing and will need to continue to prescribe for long term maintenance. These items will NOT be prescribed in primary care. But primary care should be informed the patient is receiving these items. This will include NHSE funded items requiring repatriation.  

GP - Black

Items covered by NHSE ‘Should not prescribe in primary care list’ – See CCG policy on Drugs of limited clinical value  

GP - Grey

Grey List: Items covered by NHSE ‘Should not prescribe in primary care list’ that are not to be routinely prescribed but may be suitable in a defined population – See CCG policy on Drugs of limited clinical value  

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