From the Guidelines
For ear cellulitis from an earring in a patient allergic to fluoroquinolones, the best antibiotic choice would be clindamycin 300-450 mg orally three times daily for 7-10 days, as it is effective against Staphylococcus aureus and Streptococcus species, which are the most common causes of skin and soft tissue infections related to ear piercings, and also covers MRSA, as recommended by the Infectious Diseases Society of America 1. When choosing an antibiotic for ear cellulitis from an earring, it is essential to consider the most likely causative pathogens, which include Staphylococcus aureus and Streptococcus species.
- The patient's allergy to fluoroquinolones is not a significant concern in this case, as beta-lactams and other non-fluoroquinolone antibiotics are generally preferred for treating skin and soft tissue infections.
- Clindamycin is a suitable option for patients with suspected or confirmed MRSA infection, as it has been shown to be effective against this pathogen 1.
- In addition to antibiotic therapy, the patient should remove the earring if possible, clean the area with warm saline soaks 2-3 times daily, and apply topical mupirocin ointment to the infection site.
- If the infection worsens despite oral antibiotics, shows signs of abscess formation, or if the patient develops fever or significant ear swelling, they should seek immediate medical attention as intravenous antibiotics may be necessary. The recommended duration of antimicrobial therapy is 5 days, but treatment should be extended if the infection has not improved within this time period, as stated in the practice guidelines for the diagnosis and management of skin and soft tissue infections: 2014 update by the Infectious Diseases Society of America 1.
From the FDA Drug Label
Clindamycin is indicated in the treatment of serious infections caused by susceptible anaerobic bacteria. Clindamycin is also indicated in the treatment of serious infections due to susceptible strains of streptococci, pneumococci, and staphylocci Its use should be reserved for penicillin-allergic patients or other patients for whom, in the judgment of the physician, a penicillin is inappropriate. Serious skin and soft tissue infections
The best antibiotic for ear cellulitis from an earring in a patient allergic to fluoroquinolones (FQs) may be clindamycin.
- Key points:
- Clindamycin is effective against susceptible strains of streptococci, pneumococci, and staphylococci.
- It is used for serious skin and soft tissue infections.
- Use should be based on bacteriologic studies to determine the causative organisms and their susceptibility to clindamycin 2
From the Research
Ear Cellulitis from Earring Infection
For a patient allergic to fluoroquinolones (FQs), the best antibiotic for ear cellulitis from an earring can be determined by considering the causative pathogens and alternative antibiotic options.
- The most common causes of ear cellulitis are Staphylococcus aureus and Streptococcus pyogenes 3.
- Given the patient's allergy to FQs, alternative antibiotics such as amoxicillin/clavulanate, dicloxacillin, cephalexin, clindamycin, doxycycline, minocycline, trimethoprim/sulfamethoxazole, and macrolides can be considered 3.
- For methicillin-resistant S. aureus (MRSA) infections, clindamycin, trimethoprim/sulfamethoxazole, and vancomycin are potential options 3, 4.
- Topical antibiotics like mupirocin, retapamulin, and fusidic acid can also be effective for mild to moderate infections 3.
Considerations for Antibiotic Selection
When selecting an antibiotic, it is essential to consider the severity of the infection, the patient's medical history, and the potential for antibiotic resistance 5, 4.
- The use of fluoroquinolones is generally reserved for complicated infections or as an alternative to other antibiotics 5.
- The patient's allergy to FQs should be taken into account to avoid adverse reactions 6.
Treatment Options
Based on the available evidence, treatment options for ear cellulitis from an earring in a patient allergic to FQs may include: