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Royal United Hospitals Bath NHS Foundation Trust
Great Western Hospitals NHS Foundation Trust
Salisbury NHS Foundation Trust
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 Formulary Chapter 12: Ear, nose and oropharynx - Full Chapter
Notes:

ENT related prescribing guidance

Please see our Prescribing Guidelines page for a full list of guidance available.

ENT Shared Care Agreements

There are no shared care agreements available for ENT.

Self-care

Many of the products in this chapter are available for purchase over-the-counter, and patients are encouraged to self-care, with the support of their community pharmacist, in the first instance.

For further information on self-care & the NHS, please refer to https://www.england.nhs.uk/medicines/conditions-for-which-over-the-counter-items-should-not-routinely-be-prescribed/

 Details...
12.01  Expand sub section  Drugs acting on the ear
12.01.01  Expand sub section  Otitis externa
12.01.01  Expand sub section  Astringent preparations
Acetic Acid 2%
(spray)
View adult BNF View SPC online
Formulary
traffic lightSelf
  • Please note: Patients should self-care in the first instance

 

 
Link  BSW Management of Infection Guidance for Primary Care
 
12.01.01  Expand sub section  Anti-inflammatory preparations
 note 

For treatment of otitis externa in primary care see BSW Management of Infection Guidance for Primary Care 

Betamethasone sodium phosphate drops 0.1%
(Ear drops )
View adult BNF View SPC online
Formulary
traffic lightGreen
  • Ear drops 0.1%  
  • Prolonged use of topical corticosteroids should be avoided.
  • Betamethasone products for use in nasal allergy please refer to 12.2.1
 
 
Prednisolone
(ear drops)
View adult BNF View SPC online
Formulary
traffic lightGreen
  • Ear drops 0.5%
 
 
Dexamethasone with Antibacterial
(Otomize®)
(Ear spray)
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Formulary
traffic lightGreen
  • Dexamethasone 0.1%, neomycin sulfate 3250 units/ml, glacial acetic acid 2%
 
 
Dexamethasone with Antibacterials
(Sofradex®)
(ear drops)
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Formulary
traffic lightGreen
  • Dexamethasone 0.05%, framycetin sulfate 0.5%, gramicidin 0.005%  
 
 
Flumetasone 0.02% with Clioquinol 1%
(ear drops)
View adult BNF View SPC online
Formulary
traffic lightGreen
  • Previously Locorten-Vioform®  (discontinued)
 
 
Hydrocortisone Acetate 1% with Gentamicin 0.3%
(ear drops)
View adult BNF View SPC online
Formulary
traffic lightGreen
  • Previously Gentisone HC (discontinued)
 
 
Hydrocortisone with Antibacterial
(Otosporin®)
(ear drops)
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Formulary
traffic lightGreen
  • Hydrocortisone 10 mg /Neomycin sulfate 3400 unit /Polymyxin B sulfate 10000 unit per 1 ml
  • 10ml

 

 
 
Betamethasone 0.1% with Neomycin 0.5%
(Betnesol N®)
(ear drops)
View adult BNF View SPC online
Formulary
traffic lightGreen
 
 
12.01.01  Expand sub section  Anti-infective preparations to top
Ciprofloxacin
(Ear drops)
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Formulary
traffic lightAmber
  • 2 mg/ml ear drops solution in single-dose container
  • Licensed for the treatment of acute otitis externa in adults and children older than 1 year with an intact tympanic membrane
  • The ampoule contents should be used immediately after opening the single dose ampoule.
  • Each pack contains 15 ampoules
  • Salisbury only
 
 
Ciprofloxacin 0.3%
(eye drops)
View adult BNF View SPC online
Formulary
traffic lightGreen
  • GWH ENT use eye drops in the ear (off-label)
 
 
Clotrimazole 1%
(solution)
View adult BNF View SPC online
Formulary
traffic lightGreen
  • 1% solution is licensed to be used as ear drops
 
 
Gentamicin 0.3%
(Ear Drops)
View adult BNF View SPC online
Formulary
traffic lightGreen
  • Ear drop 0.3%   
 
 
Ofloxacin 0.3%
(eye drops-off label use for ears)
View adult BNF View SPC online
Formulary
traffic lightAmber
  • Eye drops 0.3% (off label use)
  • For chronic otitis media
 
 
12.01.01  Expand sub section  Other aural preparations
12.01.02  Expand sub section  Otitis media
 note 

For treatment of otitis media in primary care see BSW Management of Infection Guidance for Primary Care

12.01.03  Expand sub section  Removal of ear wax
Olive Oil Ear Drops
View adult BNF View SPC online
Formulary
traffic lightSelf
  • Please note: Patients should self-care in the first instance
 
 
Sodium Bicarbonate 5% (ear drps)
Formulary
traffic lightSelf
  • Ear drops 5%  
  • Please note: Patients should self-care in the first instance
 
 
12.02  Expand sub section  Drugs acting on the nose
 note 

See Local Allergic Rhinitis guidance for adults: BCAP Allergic Rhinitis Guidance 2018 and MMT statement on the treatment of hayfever.

Please see MHRA Drug Safety Update August 2017 for information and advice on the rare risk of central serous chorioretinopathy with local and systemic administration of corticosteroids.

Allergic rhinitis: short term treatment, start treatment 2-3 weeks before season starts. Many of the products are available for self-purchase and self-care.

Perennial rhinitis: long term therapy required.

12.02.01  Expand sub section  Drugs used in nasal allergy to top
12.02.01  Expand sub section  Antihistamines
Azelastine
(Nasal spray)
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Formulary
traffic lightGreen
  • 140micrograms/dose nasal spray 22ml
  • Useful option for patients who do not want to try a corticosteroid or have contra-indications to them

 

 
 
12.02.01  Expand sub section  Corticosteroids
Mometasone Furoate
(spray)
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First Choice
traffic lightGreen
  • Nasal spray 50 micrograms per spray
  • First line for treatment of allergic rhinits (prescribe generically)
  • For ENT initiation only for the treatment of nasal polyps.

 

 

 

 
Beclometasone Dipropionate (spray)
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First Choice
traffic lightSelf
  • 200 dose nasal spray, 50 micrograms per spray     
  • Beclomethasone is licensed for the prophylaxis and treatment of allergic and vasomotor rhinitis.    
  • First line for treatment of allergic rhinits  . OTC for over 18 years.

 

 

 

 
Budesonide (Nasal spray)
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Second Choice
traffic lightGreen
  • Budesonide nasal spray 64micrograms / spray 120 dose
  • Second line for the treatment of allergic rhinitis
  • Licensed for nasal polyps.

 

 
 
Fluticasone furoate (Nasal spray)
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Second Choice
traffic lightGreen
  • Fluticasone furoate nasal spray, 27.5 micrograms per spray
  • Second line for the treatment of allergic rhinitis

 

 

 

 
 
Fluticasone Propionate
(nasal drops)
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Third Choice
traffic lightGreen
  • Nasal drops 400 micrograms/unit dose  
  • Only for the treatment of nasal polyps and associated symptoms of nasal obstruction.
  • Only to be used 3rd line as per the Local allergic rhinitis guidance (see top of this section for guidance links) March 2018

 

 

 

 
 
Fluticasone + Azelastine
(Nasal spray)
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Third Choice
traffic lightGreen
  • Azelastine 137 micrograms and Fluticasone propionate 50 micrograms per actuation
  • Only to be used 3rd line as per the local allergic rhinitis guidance  
 
 
Betamethasone Sodium Phosphate 0.1%
(nasal drops)
View adult BNF View SPC online
Formulary
traffic lightGreen
  •  5ml nasal drops

 

 
 
12.02.02  Expand sub section  Topical nasal decongestants
12.02.02  Expand sub section  Sympathomimetics
Xylometazoline
(Nasal drops and spray)
View adult BNF View SPC online
First Choice
traffic lightSelf
  • Nasal drops 0.1% and 0.05% (paedatric) 10ml
  • Spray 0.1% 10ml
 
Ephedrine
(nasal drops)
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Formulary
traffic lightSelf
  • Nasal drops 0.5%
  • 1% 10ml     

 

 
 
12.02.02  Expand sub section  Antimuscarinic to top
Ipratropium Bromide 0.03%
(Nasal spray)
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First Choice
traffic lightGreen
  • nasal spray 0.03%      
  • Useful for watery rhinorrhoea
 
12.02.03  Expand sub section  Nasal preparations for infection
Bismuth + iodoform impregnated gauze (BIPP)
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Formulary
traffic lightRed
  • A paste of composition Iodoform 40% w/w, Bismuth Subnitrate 20% w/w and Paraffin Liquid 40% w/w. presented in a labelled aluminium laminated pouch.
 
 
12.02.03  Expand sub section  Nasal Staphylococci
Chlorhexidine Hydrochloride 0.1%, Neomycin Suphate 0.5%
(Naseptin®)
(Nasal cream 15g)
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Formulary
traffic lightGreen
  • Contains arachis oil: Should be avoided in peanut or soya allergy
  • To avoid the development of resistance, the treatment course should not exceed 7 days and the course not repeated on more than one occasion  
 
 
Mupirocin 2%
(Bactroban ®)
(Nasal ointment 3g)
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Formulary
traffic lightGreen
  • Mupirocin (Bactroban® nasal) is of value when the carriage of Staphlococcus aureus in the nose or ears has to be cleared.
  • To avoid the development of resistance, the treatment course should not exceed 7 days and the course not repeated on more than one occasion

 

 

 
 
Prontoderm
(Nasal gel)
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Formulary
traffic lightGreen
  • 30ml
  • As an alternative for decolonisation of MRSA
  • To avoid the development of resistance, the treatment course should not exceed 7 days and the course not repeated on more than one occasion
 
 
12.03  Expand sub section  Drugs acting on the oropharynx
12.03.01  Expand sub section  Drugs for oral ulceration and inflammation
Benzydamine
(oral)
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Formulary
traffic lightSelf
  • oral rinse 0.15% 300ml
  • oromucosal spray 0.15% 30ml
 
 
Caphosol ®
(Medical Device)
(mouthwash)
View adult BNF View SPC online
Formulary
traffic lightRed
  • GWH only: Restricted for use in patients undergoing autologous stem cell transplant only. Consultant haematologist prescription only.
 
 
Carmellose Sodium
(Orabase®)
View adult BNF View SPC online
Formulary
traffic lightSelf
  • Please note: Patients should self-care in the first instance
 
 
Choline Salicylate
View adult BNF View SPC online
Formulary
traffic lightSelf
  • Please note: Patients should self-care in the first instance
  • 8.7% dental gel 15g
 
 
Gelclair ®Oral gel sachet
(Medical device)
View adult BNF View SPC online
Formulary
traffic lightRed
  • GWH and RUH 
  • Contains sodium hyaluronate and polyvinylpyrrolidone
  • Used as a mouthwash for oropharyngeal lesions in Oncology patients
 
 
Hydrocortisone muco-adhesive buccal tablets
View adult BNF View SPC online
Formulary
traffic lightGreen
  •  2.5mg   (as sodium succinate)  
  • P medicine can be purchased OTC
 
Link  MHRA DSU Hydrocortisone muco-adhesive buccal tablets: should not be used off-label for adrenal insufficiency in children due to serious risks Dec 2018
 
Lidocaine 5% ointment (mouth)
View adult BNF View SPC online
Formulary
traffic lightRed
  • GWH only
 
 
Antacid with Oxetacaine
((Magnesium Hydroxide & Aluminium Hydroxide))
View adult BNF View SPC online
Unlicensed Drug Unlicensed
traffic lightRed
  • Oral suspension: Each 5ml contains 10mg Oxetacaine, Aluminium hydroxide equivalent to 200mg aluminium oxide + 100mg magnesium hydroxide 150ml bottle.
  • Not on formulary in GWH and SFT
  • RUH only - Antacid and anaesthetic relief of oesophageal pain in palliative care patients (unlicensed)

 

 
 
12.03.02  Expand sub section  Oropharyngeal anti-infective drugs to top
12.03.02  Expand sub section  Oropharyngeal Fungal infections
Nystatin
(oral suspension)
View adult BNF View SPC online
First Choice
traffic lightGreen
  • Always prescribe by BRANDNAME in primary care to get most cost-effective version.
  • 100,000 units/ml 30ml bottle
  • Dose:  ADULT and CHILD over 2 years, 100 000 units 4 times daily
  • Due to the high sucrose content of nystatin suspension, 500mg/1ml, ensure that diabetic patients are aware of this.
  • Nystatin is the first line choice, however miconazole may be considered due to the differing formulations.
 
Miconazole
(oral gel)
View adult BNF View SPC online
Formulary
traffic lightGreen
  • Oral gel 20mg/g 15g/80g
 
Link  MHRA DSU Sept 2017 Miconazole (Daktarin): over-the-counter oral gel contraindicated in patients taking warfarin
 
12.03.02  Expand sub section  Oropharyngeal Viral infections
12.03.03  Expand sub section  Lozenges and sprays
 note 
  • Note: Lozenges and sprays have not been considered for formulary inclusion. The BNF states: ‘There is no convincing evidence that antiseptic lozenges and sprays have a beneficial action and they sometimes irritate and cause sore tongue and sore lips. Some of these preparations also contain local anaesthetics, which relieve pain but may cause sensitisation.’

12.03.04  Expand sub section  Mouthwashes, gargles, and dentifrices
Chlorhexidine gluconate 1%
(dental gel)
View adult BNF View SPC online
Formulary
traffic lightRed
  • GWH ICU only
 
 
Chlorhexidine mouthwash 0.2%
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Formulary
traffic lightSelf
  •  300ml or 600ml bottles
 
 
Hydrogen Peroxide
(solution)
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Formulary
traffic lightSelf
  • Use as mouthwash
  • 20vols (6%) 
  • 10vols (3%)
 
 
12.03.05  Expand sub section  Treatment of dry mouth to top
 note 
  • All of the available artificial saliva preparations may be purchased from a pharmacy and most of the products cost the same or less than a prescription charge. The majority of artificial saliva products can be prescribed on a dental NHS prescription.

12.03.05  Expand sub section  Local Treatment
Biotene Oralbalance ®
(oral gel)
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Formulary
traffic lightGreen
  • Saliva replacement oral gel
  • 50g
  • ACBS
 
 
Glandosane ® (spray)
View adult BNF View SPC online
Formulary
traffic lightGreen
  • ACBS
  • 50ml spray
  • Lemon, Peppermint or natural
 
 
Oralieve® (spray)
View adult BNF View SPC online
Formulary
traffic lightGreen
  • Xylitol/peroxidase and oxidase enzymes
  • 50ml
 
 
Saliveze ® (spray)
View adult BNF View SPC online
Formulary
traffic lightGreen
  • 50ml
  • ACBS
 
 
Salivix ® (pastilles)
View adult BNF View SPC online
Formulary
traffic lightGreen
  • sugar-free
  • reddish-amber, acacia, malic acid and other ingredients
  • ACBS
 
 
12.03.05  Expand sub section  Systemic treatment
Pilocarpine Hydrochloride (Oral)
View adult BNF View SPC online
Formulary
traffic lightGreen
  • Swindon and Salisbury areas only, not previously on BCAP formulary
  • 5mg tablets
  • Useful in refractory sjogrens
 
 
 ....
 Non Formulary Items
ACETIC ACID 5% solution in IMS

View adult BNF View SPC online
Non Formulary
 
Almond Oil

View adult BNF View SPC online
Non Formulary
 
Amphotericin Lozenges
(Fungilin®)

View adult BNF View SPC online
Non Formulary
 
Anaesthetic throat lozenges
(Tyrozets®)

View SPC online
Non Formulary
 
AS saliva Orthana ®

View adult BNF View SPC online
Non Formulary
 
Benzocaine

View adult BNF View SPC online
Non Formulary
 
BioXtra ®

View adult BNF View SPC online
Non Formulary
 
Carmellose Sodium
(Orahesive®)

View adult BNF View SPC online
Non Formulary
 
Cerumol ®

View adult BNF View SPC online
Non Formulary
 
Cetylpyridinium, Chlrocresol, Lidocaine
(Anbesol®)

View adult BNF View SPC online
Non Formulary
 
Docusate 0.5% eardrops
(Waxsol®)

View adult BNF View SPC online
Non Formulary
 
Doxycycline
(Periostat®)

View adult BNF View SPC online
Non Formulary
 
Exterol ®

View adult BNF View SPC online
Non Formulary
 
Flunisolide (Syntaris®)

View adult BNF View SPC online
Non Formulary
 
Flurbiprofen lozenge

View adult BNF View SPC online
Non Formulary
 
Fluticasone Propionate
(Nasofan®)

View adult BNF View SPC online
Non Formulary
 
Glycerol dioleate (Episil®)

View adult BNF View SPC online
Non Formulary
 
Lidocaine 10% mouth spray

View adult BNF View SPC online
Non Formulary
 
Lidocaine and Cetylpyridinium
(Dentinox® Teething Gel)

View adult BNF View SPC online
Non Formulary
 
Lidocaine and Chlorhexidine
(Instillagel®)
(mouth)

View adult BNF View SPC online
Non Formulary
 
Lidocaine and Phenylephrine
(Cophenalcaine®)

View adult BNF View SPC online
Non Formulary
 
Miconazole (Loramyc®)

View adult BNF View SPC online
Non Formulary
 
Molcer ®

View adult BNF View SPC online
Non Formulary
 
Mouth Swabs

View adult BNF View SPC online
Non Formulary
 
Neomycin Sulphate with corticosteroids
(Neo-Cortef®)

View adult BNF View SPC online
Non Formulary
 
Neomycin Sulphate with corticosteroids
(Otosporin®)

View adult BNF View SPC online
Non Formulary
 
Otex ®

View adult BNF View SPC online
Non Formulary
 
Povidone Iodine
(Betadine®)

View adult BNF View SPC online
Non Formulary
 
Prednisolone 0.5% with Neomycin 0.5%
(Predsol-N®)

View adult BNF View SPC online
Non Formulary
 
Salicylates - Salicylic acid
(Pyralvex®)

View adult BNF View SPC online
Non Formulary
 
Salinum ®

View adult BNF View SPC online
Non Formulary
 
SST

View adult BNF View SPC online
Non Formulary
 
Thymol

View adult BNF View SPC online
Non Formulary
 
Triamcinolone Acetonide
(Nasacort®)

View adult BNF View SPC online
Non Formulary
 
Triamcinolone Acetonide 0.1% in Adhesive Basis
(Adcortyl in Orabase®)

View adult BNF View SPC online
Non Formulary

 

This product was discontinued in the UK in March 2009

 
Triamcinolone with antibacterial
(Otocomb Otic®)

View adult BNF View SPC online
Non Formulary
 
Triamcinolone with Antibacterial
(Tri-Adcortyl Otic®)

View adult BNF View SPC online
Non Formulary
 
Xerotin(r)
(Xerotin®)

View adult BNF View SPC online
Non Formulary
 
  
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
click to search medicines.org.uk
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
Blueteq
High Cost Drug Approval System

Traffic Light Status Information

Status Description

Traffic LightRed

RED - Hospital only – to be prescribed by a specialist and supplied from secondary care ONLY throughout treatment.  

Traffic LightAmber

Amber medicines are considered suitable for GP prescribing following specialist initiation or recommendation.  

Traffic LightAmber with Shared Care

Shared Care - these medicines require specialist initiation and stabilisation. Ongoing division of responsibility for drug and disease monitoring between specialist and GP by a Shared Care Guideline (SCG). If no SCG in place status reverts to red.  

Traffic LightGreen

These medicines are appropriate for initiation in both primary and secondary care. Prescribing is appropriate within licensed or local recommendations.  

Traffic LightSelf

Suitable for patient to be directed to buy themselves  

Traffic LightGrey

Not currently used. We intend to include this TLS in future to highlight where a decision to use this medicine is under review.   

Traffic LightBlack

(In use from Oct 2020) Used where a decision has been made by the BSW APC not to routinely commission this preparation for its licensed indications. Do not prescribe.   

Traffic LightRed Specialist Centre

Not currently used. We intend to include this TLS in future to highlight where this medicine and indication is ONLY available through a Specialist Centre according to a NICE Highly Specialised Technology or NHSE Specialised Commission Circular / Policy.  

netFormulary