How should I manage treatment failure of acute diffuse otitis externa?
• Review the diagnosis and exclude and manage other conditions. • Assess and manage ongoing triggers (e.g. exposing ears to moisture, trauma to the ear canal by attempts to clean or scratch it). • Assess and manage any compliance problems. • Assess and manage factors that would impede delivery of topical medication to affected areas. • If contact dermatitis due to neomycin or other aminoglycoside is suspected, consider switching to a preparation which does not contain an aminoglycoside. • If there are systemic signs of infection, or if the infection is spreading outside the ear canal, prescribe an oral antibiotic (i.e. flucloxacillin; or erythromycin if penicillin sensitive; or clarithromycin if erythromycin and flucloxacillin are both contraindicated). • If these measures have been tried, or are not applicable: • Consider culturing a specimen of the ear canal to identify fungi and resistant bacteria. • Consider the possibility of a fungal infection and treat with topical preparation c
