From the Guidelines
Ciprofloxacin is the recommended treatment for perichondritis, particularly for cases caused by Pseudomonas aeruginosa, at a dose of 500 mg orally twice daily for 7-14 days. The treatment of perichondritis typically involves the use of fluoroquinolone antibiotics, such as ciprofloxacin or levofloxacin, as they are effective against the most common pathogens, including Pseudomonas aeruginosa, S aureus, and S pyogenes 1. It is essential to initiate treatment promptly to prevent cartilage destruction and permanent deformity. In severe cases, treatment may be extended to 3 weeks, and hospitalized patients with severe infection may require intravenous ciprofloxacin at 400 mg every 12 hours before transitioning to oral therapy. Some key points to consider when treating perichondritis with ciprofloxacin include:
- Completing the full course of antibiotics, even if symptoms improve quickly
- Avoiding manipulation of the affected area and keeping it clean and dry during treatment
- Considering drainage or surgical debridement if there's no improvement within 48-72 hours, and culture-directed antibiotic therapy should be considered 1.
From the Research
Treatment of Perichondritis with Ciprofloxacin
- Ciprofloxacin is a fluoroquinolone antibiotic that has been used to treat Pseudomonas aeruginosa infections, including perichondritis 2, 3, 4.
- A study published in 1989 reported two cases of P. aeruginosa auricular perichondritis successfully treated with oral ciprofloxacin 2.
- Another study published in 2020 reported a case of perichondritis treated with otic ciprofloxacin-hydrocortisone and IV vancomycin, with marked improvement 3.
- However, the use of fluoroquinolones in pediatric patients is still a topic of debate, and more research is needed to determine its safety and efficacy in this population 5.
Antibiotic Coverage for Perichondritis
- A study published in 2019 found that Staphylococcus aureus was the predominant pathogen in non-abscess perichondritis, and that antibiotic coverage should be expanded to include P. aeruginosa if the clinical response is disappointing or cultures grow P. aeruginosa 6.
- The same study suggested that intravenous antibiotic therapy covering S. aureus is sufficient and appropriate empirical treatment in the majority of patients with non-abscess perichondritis 6.
- Another study published in 2020 discussed the management approaches for perichondritis and highlighted the importance of prompt diagnosis and treatment to prevent serious complications 5.
Current Choices of Antibiotic Treatment for P. aeruginosa Infections
- A review published in 2020 discussed the current choices of antibiotic treatment for P. aeruginosa infections, including novel fluoroquinolones, new combinations of β-lactams/β-lactamase inhibitors, and bacteriophage therapy 4.
- The review highlighted the importance of antimicrobial stewardship to preserve new drugs and prevent future development of resistance 4.