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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  Drugs acting on the ear
12.01.01  Otitis externa
12.01.01  Astringent preparations
Acetic Acid 2% 
(spray)
View adult BNF View SPC online
Formulary
Self
  • Please note: Patients should self-care in the first instance

 

 
Link  BSW Management of Infection Guidance for Primary Care
   
12.01.01  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
Green
  • 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
Green
  • Ear drops 0.5%
 
   
Dexamethasone with Antibacterial
(Otomize®)
(Ear spray)
View adult BNF View SPC online
Formulary
Green
  • Dexamethasone 0.1%, neomycin sulfate 3250 units/ml, glacial acetic acid 2%
 
   
Dexamethasone with Antibacterials
(Sofradex®)
(ear drops)
View adult BNF View SPC online
Formulary
Green
  • 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
Green
  • Previously Locorten-Vioform®  (discontinued)
 
   
Hydrocortisone Acetate 1% with Gentamicin 0.3%
(ear drops)
View adult BNF View SPC online
Formulary
Green
  • Previously Gentisone HC (discontinued)
 
   
Hydrocortisone with Antibacterial
(Otosporin®)
(ear drops)
View adult BNF View SPC online
Formulary
Green
  • 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
Green
 
   
12.01.01  Anti-infective preparations to top
Ciprofloxacin 
(Ear drops)
View adult BNF View SPC online
Formulary
Amber
  • 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
  • Used at SFT only
 
   
Ciprofloxacin 0.3% 
(eye drops)
View adult BNF View SPC online
Formulary
Green
  • GWH ENT use eye drops in the ear (off-label)
 
   
Clotrimazole 1% 
(solution)
View adult BNF View SPC online
Formulary
Green
  • 1% solution is licensed to be used as ear drops
 
   
Gentamicin 0.3% 
(Ear Drops)
View adult BNF View SPC online
Formulary
Green
  • Ear drop 0.3%   
 
   
Ofloxacin 0.3% 
(eye drops-off label use for ears)
View adult BNF View SPC online
Formulary
Amber
  • Eye drops 0.3% (off label use)
  • For chronic otitis media
 
   
12.01.01  Other aural preparations
12.01.02  Otitis media
 note 

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

12.01.03  Removal of ear wax
Olive Oil Ear Drops

View adult BNF View SPC online
Formulary
Self
  • Please note: Patients should self-care in the first instance
 
   
Sodium Bicarbonate 5%
(ear drps)
Formulary
Self
  • Ear drops 5%  
  • Please note: Patients should self-care in the first instance
 
   
12.02  Drugs acting on the nose
 note 

See Local Allergic Rhinitis guidance for adults: Allergic Rhinitis Guidance

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  Drugs used in nasal allergy to top
12.02.01  Antihistamines
Azelastine 
(Nasal spray)
View adult BNF View SPC online
Formulary
Green
  • 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  Corticosteroids
Mometasone Furoate 
(spray)
View adult BNF View SPC online
First Choice
Green
  • 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)
View adult BNF View SPC online
First Choice
Self
  • 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)
View adult BNF View SPC online
Second Choice
Green
  • Budesonide nasal spray 64micrograms / spray 120 dose
  • Second line for the treatment of allergic rhinitis
  • Licensed for nasal polyps.

 

 
   
Fluticasone furoate
(Nasal spray)
View adult BNF View SPC online
Second Choice
Green
  • Fluticasone furoate nasal spray, 27.5 micrograms per spray
  • Second line for the treatment of allergic rhinitis

 

 

 

 
   
Fluticasone Propionate
(nasal drops)
View adult BNF View SPC online
Third Choice
Green
  • 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 front page for guidance links) March 2018

 

 

 

 
   
Fluticasone + Azelastine
(Nasal spray)
View adult BNF View SPC online
Third Choice
Green
  • 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
Green
  •  5ml nasal drops

 

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

 

 
   
12.02.02  Antimuscarinic to top
Ipratropium Bromide 0.03%
(Nasal spray)
View adult BNF View SPC online
First Choice
Green
  • nasal spray 0.03%      
  • Useful for watery rhinorrhoea
 
12.02.03  Nasal preparations for infection
Bismuth + iodoform impregnated gauze (BIPP)

View adult BNF View SPC online
Formulary
Red
  • 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  Nasal Staphylococci
Chlorhexidine Hydrochloride 0.1%, Neomycin Suphate 0.5%
(Naseptin®)
(Nasal cream 15g)
View adult BNF View SPC online
Formulary
Green
  • 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)
View adult BNF View SPC online
Formulary
Green
  • 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)
View adult BNF View SPC online
Formulary
Green
  • 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  Drugs acting on the oropharynx
12.03.01  Drugs for oral ulceration and inflammation
Benzydamine 
(oral)
View adult BNF View SPC online
Formulary
Self
  • oral rinse 0.15% 300ml
  • oromucosal spray 0.15% 30ml
 
   
Caphosol ®
(Medical Device)
(mouthwash)
View adult BNF View SPC online
Formulary
Red
  • 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
Self
  • Please note: Patients should self-care in the first instance
 
   
Choline Salicylate 
View adult BNF View SPC online
Formulary
Self
  • 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
Red
  • 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
Green
  •  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
Red
  • GWH only
 
   
Antacid with Oxetacaine
((Magnesium Hydroxide & Aluminium Hydroxide))
View adult BNF View SPC online
Unlicensed Drug Unlicensed
Red
  • Oral suspension: Each 5ml contains 10mg Oxetacaine, Aluminium hydroxide equivalent to 200mg aluminium oxide + 100mg magnesium hydroxide 150ml bottle.
  • Not on formulary in GWR and SFT
  • RUH only - Antacid and anaesthetic relief of oesophageal pain in palliative care patients (unlicensed)

 

 
   
12.03.02  Oropharyngeal anti-infective drugs to top
12.03.02  Oropharyngeal Fungal infections
Nystatin 
(oral suspension)
View adult BNF View SPC online
First Choice
Green
  • 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
Green
  • 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  Oropharyngeal Viral infections
12.03.03  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  Mouthwashes, gargles, and dentifrices
Chlorhexidine gluconate 1%
(dental gel)
View adult BNF View SPC online
Formulary
Red
  • GWH ICU only
 
   
Chlorhexidine mouthwash 0.2%

View adult BNF View SPC online
Formulary
Self
  •  300ml or 600ml bottles
 
   
Hydrogen Peroxide  
(solution)
View adult BNF View SPC online
Formulary
Self
  • Use as mouthwash
  • 20vols (6%) 
  • 10vols (3%)
 
   
12.03.05  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  Local Treatment
Biotene Oralbalance ®
(oral gel)
View adult BNF View SPC online
Formulary
Green
  • Saliva replacement oral gel
  • 50g
  • ACBS
 
   
Glandosane ®
(spray)
View adult BNF View SPC online
Formulary
Green
  • ACBS
  • 50ml spray
  • Lemon, Peppermint or natural
 
   
Oralieve®
(spray)
View adult BNF View SPC online
Formulary
Green
  • Xylitol/peroxidase and oxidase enzymes
  • 50ml
 
   
Saliveze ®
(spray)
View adult BNF View SPC online
Formulary
Green
  • 50ml
  • ACBS
 
   
Salivix ®
(pastilles)
View adult BNF View SPC online
Formulary
Green
  • sugar-free
  • reddish-amber, acacia, malic acid and other ingredients
  • ACBS
 
   
12.03.05  Systemic treatment
Pilocarpine Hydrochloride
(Oral)
View adult BNF View SPC online
Formulary
Green
  • GWH and SFT only
  • 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

Red

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

Amber

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

Amber 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.  

Green

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

Self

Suitable for patient to be directed to buy themselves  

Grey

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

Black

(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.   

Red 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.  

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