From the Guidelines
Yes, a patient with a piercing site infection should generally remove the metallic jewelry to allow proper drainage and healing. The first step is to remove the jewelry if the infection is mild to moderate, as the metal can harbor bacteria and impede drainage 1. After removal, clean the area 2-3 times daily with warm saline solution (1/4 teaspoon salt in 8 ounces of warm water) or an antiseptic solution like chlorhexidine. Apply a topical antibiotic such as bacitracin or mupirocin to the site after cleaning. For more severe infections with significant redness, swelling, pain, or discharge, oral antibiotics may be necessary - common options include cephalexin 500mg four times daily or clindamycin 300mg three times daily for 7-10 days 1. Warm compresses applied for 15 minutes several times daily can help reduce swelling and promote drainage. However, for certain infections, especially those involving cartilage (like ear cartilage piercings), a healthcare provider might recommend keeping the jewelry in place to maintain the tract while treating the infection, as cartilage infections can be more serious and difficult to treat. If symptoms worsen, if there's fever, increasing pain, or spreading redness, seek immediate medical attention as this could indicate a more serious infection requiring different treatment. Some key considerations for managing piercing site infections include:
- Removing the jewelry to allow for proper drainage and healing
- Cleaning the area with warm saline or antiseptic solution
- Applying topical antibiotics
- Using oral antibiotics for more severe infections
- Applying warm compresses to reduce swelling and promote drainage
- Seeking medical attention if symptoms worsen or if there are signs of a more serious infection. It's also important to note that the management of piercing site infections may vary depending on the location and severity of the infection, as well as the individual patient's overall health and medical history 1.
From the Research
Piercing Site Infection Treatment
- The decision to remove a metallic piercing in the case of an infection should be based on the severity of the infection and the type of bacteria causing it 2.
- Studies have shown that between 10% and 20% of all piercings lead to a local infection, with Staphylococcus aureus, group A Streptococcus, and Pseudomonas sp. being the most common causal agents 2.
- In cases of purulent skin and soft tissue infections, antibiotics such as doxycycline, trimethoprim-sulfamethoxazole, and clindamycin have been shown to be effective against community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) 3, 4, 5, 6.
- The use of these antibiotics, often in combination with incision and drainage, has been associated with improved treatment outcomes and reduced risk of treatment failure 5, 6.
- However, there is no direct evidence to suggest that removing a metallic piercing is necessary or beneficial in the treatment of a piercing site infection, and this decision should be made on a case-by-case basis, taking into account the individual patient's circumstances and the severity of the infection.
Antibiotic Treatment Options
- Trimethoprim-sulfamethoxazole and clindamycin have been shown to be effective against CA-MRSA and are often used as first-line treatment options for skin and soft tissue infections 4, 5, 6.
- Doxycycline is also effective against CA-MRSA and can be used as an alternative to trimethoprim-sulfamethoxazole and clindamycin 3.
- Cephalexin is not effective against CA-MRSA and should not be used as empiric therapy for cellulitis in areas with a high prevalence of CA-MRSA infections 6.
Treatment Outcomes
- Studies have shown that incision and drainage, in combination with antibiotic therapy, is critical for the management of CA-MRSA skin infections 5.
- The use of antibiotics with activity against CA-MRSA, such as trimethoprim-sulfamethoxazole and clindamycin, has been associated with improved treatment outcomes and reduced risk of treatment failure 5, 6.