What are the recommended first-line treatments for a patient diagnosed with otitis externa?

Recommended first-line treatments for otitis externa include:

• Providing advice on self-care measures such as keeping the ear clean and dry, avoiding swimming and water sports for 7–10 days, and protecting the ear from water exposure during bathing or hair washing using ear plugs or cotton wool with petroleum jelly. Consider using a hair dryer on the lowest heat setting to dry the ear canal after water exposure.
• Consider use of over-the-counter acetic acid 2% ear drops or spray for people aged 12 years and older, applied morning, evening, and after water exposure for up to 7 days to reduce bacterial growth and promote healing.
• Performing aural toilet to clean the ear canal by dry swabbing of secretions or ear irrigation if the tympanic membrane is intact and the patient is not immunocompromised, to remove debris and exudate and improve topical treatment efficacy.
• Prescribing topical antibiotic ear preparations for 7–14 days, with or without a topical corticosteroid, depending on clinical judgement and symptom response. Antibiotic eardrops containing quinolones (e.g., ciprofloxacin) are preferred due to rapid symptom relief and lower recurrence rates. Avoid ototoxic preparations (e.g., aminoglycosides or alcohol-containing drops) if tympanic membrane perforation is suspected.
• Advising on correct ear drop administration technique to improve treatment efficacy and compliance.
• Offering analgesia such as paracetamol or ibuprofen for pain relief as needed.

Oral antibiotics are generally not recommended for uncomplicated acute otitis externa due to limited efficacy and increased risk of adverse effects and resistance, but may be considered if there is severe infection, cellulitis spreading beyond the ear canal, or immunocompromise.

Arrange follow-up if symptoms do not improve within 48–72 hours, persist beyond 2 weeks, or if there are severe symptoms or immunocompromise.

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