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12. Ear, Nose and Oropharynx

CD&D APC Patient Decision Aids Resource available at: http://medicines.necsu.nhs.uk/guidelines/durham-darlington/

 

CD&D APC “Do Not Prescribe List” and “Grey List – drugs prescribed under limited circumstances” available at: http://medicines.necsu.nhs.uk/guidelines/durham-darlington/

NHS England Guidance on “Conditions for which over the counter items should not routinely be prescribed” available at: https://www.england.nhs.uk/medicines/conditions-for-which-over-the-counter-items-should-not-routinely-be-prescribed/

Anti-inflammatory Preparations
First Choice
• Betamethasone
Alternative
• Prednisolone


Anti-infective Preparations
• Gentamicin
• Chloramphenicol
• Clotrimazole


Compound Antibacterial / Corticosteroid Preparations
First Choice
• Gentamicin and Hydrocortisone
Alternatives
• Sofradex®
• Otomize®
• Betamethasone and Neomycin
• Otosporin®

Betamethasone
BNF | BNFC | SPC

Ear Drops - 0.1%

Prednisolone
BNF | BNFC | SPC

Ear Drops - 0.5%

Gentamicin
BNF | BNFC | SPC

Ear Drops - 0.3%

Chloramphenicol
BNF | BNFC | SPC

5% (or 10%) ear drops (in propylene glycol)

Clotrimazole
BNF | BNFC | SPC

1% solution

Gentisone HC
BNF | BNFC | SPC

Ear Drops

Sofradex
BNF | BNFC | SPC

Eye/ear drops containing dexamethasone 0.05%, framycetin sulphate 0.5% & gramicidin 0.005%

Otomize
BNF | BNFC | SPC

Ear Spray

Betnesol-N
BNF | BNFC | SPC

Ear Drops

Otosporin
BNF | BNFC | SPC

Ear drops containing hydrocortisone 1%, neomycin sulph. 0.439% & polymyxin B sulph. 10,000 units/ml

Olive Oil
BNF | BNFC | SPC

Ear DropsOTC

Sodium Bicarbonate
BNF | BNFC | SPC

Ear Drops - 5%OTC

Beclometasone
BNF | BNFC | SPC

Nasal Spray - 50 microgram

Betamethasone
BNF | BNFC | SPC

0.1% eye/ear/nose drops (betamethasone sod. phos.)

Fluticasone Furoate (Avamys)
BNF | BNFC | SPC

27.5 microgram / dose nasal spray.

N.B. Take care to
avoid confusion with fluticasone propionate

Fluticasone Propionate
BNF | BNFC | SPC

50 microgram / dose nasal sprayOTC

400 microgram unit dose nasal drops

N.B. Take care to avoid confusion with fluticasone
furoate



Mometasone
BNF | BNFC | SPC

Nasal Spray - 50 microgram

Triamcinolone acetonide
BNF | BNFC | SPC

55 microgram metered dose nasal sprayOTC

Azelastine
BNF | BNFC | SPC

0.1% nasal spray (140 micrograms/metered spray)

Sodium Cromoglycate
BNF | BNFC | SPC

Nasal Spray - 4%

Xylometazoline
BNF | BNFC | SPC

Nasal Spray - 0.1%

Ipratropium
BNF | BNFC | SPC

Nasal Spray - 0.03%

Sodium Chloride
BNF | BNFC | SPC

0.9% nasal drops

Ephedrine
BNF | BNFC | SPC

0.5% & 1% nasal drops

Mupirocin
BNF | BNFC | SPC

Nasal Ointment - 2% 

First choice for use in MRSA eradication.

Chlorhexidine 0.1% Neomycin 0.5%
BNF | BNFC | SPC

Cream

MRSA Only

Bismuth Subnitrate and Iodoform (BIPP) Paste
BNF | BNFC | SPC

Paste 1.25cm x 100cm & 2.5cm x 100cm impregnated gauze

Benzydamine
BNF | BNFC | SPC

Oral Rinse - 0.15%

Spray

Orabase
BNF | BNFC | SPC

PasteOTC containing carmellose sodium 16.7%, pectin 16.7%
& gelatin 16.7% in plastibase

Hydrocortisone
BNF | BNFC | SPC

Mucoadhesive Buccal Tablets - 2.5mgOTC

Choline salicylate
BNF | BNFC | SPC

Oral Gel - 8.7% (Bonjela)OTC

Hyaluronan
BNF | BNFC | SPC

0.2% gel & 0.025% mouthwash (Gengigel)

For limited second-line use on specialist advice in the treatment of orofacial granulomatosis, severe oral ulceration and mucositis secondary to mmunosuppression where conventional treatments are unsuitable or
have failed.

MuGard®
Restricted to use in patients who are currently on sunitinib (Sutent®) treatment, and is cheaper than treatment that is currently used.

Caphosol
BNF | BNFC | SPC

1 dose=1 x 15ml Caphosol A + 1 x 15ml Caphosol B mixed
together

CD&D APC Grey List: For limited use in patients having chemo-radiotherapy or radiotherapy to malignancies of the oral cavity, hypopharnyx and oro-pharynx on specialist recommendation.

Doxycycline
BNF | BNFC | SPC

20mg tablets

For Periodontitis

Miconazole
BNF | BNFC | SPC

Oral Gel - 24mg/ml

Gel not recommended under 4m of age due to choking risk

MHRA Drug Safety Update (June 2016): Topical miconazole, including oral gel: reminder of potential for serious interactions with warfarin

MHRA Drug Safety Update (Sept 2017): Miconazole (Daktarin): over-the-counter oral gel contraindicated in patients taking warfarin

Nystatin
BNF | BNFC | SPC

Suspension - 100,000units/ml

 

Amphotericin
BNF | BNFC | SPC

100mg/1ml oral suspension

Miconazole Muco-adhesive Buccal Tablets
BNF | BNFC | SPC

50mg muco-adhesive buccal tablets

Restricted to use in immunocompromised patients with severe oropharyngeal candidiasis, where the use of other antifungal agents e.g. nystatin, fluconazole is not appropriate and for use on the advice of microbiologists.

Aciclovir
BNF | BNFC | SPC

Tablets & suspension – see section 5.3.2

Cetylpyridinium Chloride (Merocet)
BNF | BNFC | SPC

1.4 mg lozengesOTC

Merocaine
BNF | BNFC | SPC

Lozenges (benzocaine 10mg + cetylpyridinium Cl 1.4mg)OTC

Chlorhexidine
BNF | BNFC | SPC

Mouthwash - 0.2%

Dental Gel - 1%

Chlorhexidene Dental Gel
BNF | BNFC | SPC

2% oral gelu

For hospital use in the prevention of ventilator-associated pneumonia in adult patients who are ventilated (for >48 hours).

Hexitidine
BNF | BNFC | SPC

0.1% mouthwash

Mouthwash Solution Tablets
BNF | BNFC | SPC

Solution tablets containing antimicrobial, flavouring and
colouring agents

Triclosan (Mentadent P)
BNF | BNFC | SPC

Toothpaste containing triclosan - for use in MRSA eradication. If Mentadent P is not available, Colgate Total is a suitable alternative.

AS Saliva Orthana
BNF | BNFC | SPC

Oral Spray

Preferred to Glandosane as it is less likely to damage tooth enamel

Biotene
BNF | BNFC | SPC

Oralbalance Gel

Prescribable on the NHS in primary care as a Borderline Substance.

Glandosane
BNF | BNFC | SPC

Spray

Malic Acid (Salivix)
BNF | BNFC | SPC

Sugar-free pastilles containing malic acid

Pilocarpine
BNF | BNFC | SPC

5mg tablets

Treatment to be initiated with specialist advice.

BioXtra
BNF | BNFC | SPC

Salivary gel and toothpaste.

The gel, but not the toothpaste, is prescribable on the NHS in primary care as a Borderline Substance.