From the Guidelines
The best treatment for perichondritis is prompt antibiotic therapy targeting Pseudomonas aeruginosa, the most common causative organism, with fluoroquinolone antibiotic treatment, such as ciprofloxacin or levofloxacin, as the first line of treatment. This approach is based on the most recent and highest quality evidence available, which highlights the effectiveness of fluoroquinolones in treating perichondritis 1. The initial treatment typically involves oral fluoroquinolones, and for more severe cases, hospitalization with intravenous antibiotics like clindamycin, ceftazidime, and cefepime may be necessary 1.
Key Considerations
- The most common pathogens responsible for perichondritis, including Pseudomonas aeruginosa, S aureus, and S pyogenes, often respond well to fluoroquinolone antibiotic treatment 1.
- If an abscess is present, surgical incision and drainage are often necessary to prevent further complications 1.
- Earrings should be removed, and any suspected infection should be treated promptly to prevent the progression of the infection 1.
- Pain management with acetaminophen or NSAIDs is also recommended to improve the patient's quality of life 1.
Treatment Approach
- Initial treatment: oral fluoroquinolones, such as ciprofloxacin or levofloxacin, for 7-10 days 1.
- Severe cases: hospitalization with intravenous antibiotics, such as clindamycin, ceftazidime, and cefepime 1.
- Abscess drainage: surgical incision and drainage to prevent further complications 1.
- Pain management: acetaminophen or NSAIDs to improve the patient's quality of life 1.
From the Research
Treatment Options for Perichondritis
The treatment for perichondritis depends on the severity of the disease and the presence of abscess or non-abscess infections.
- For non-abscess perichondritis, intravenous antibiotic therapy covering Staphylococcus aureus is sufficient and appropriate empirical treatment in the majority of patients 2.
- However, antibiotic coverage should be expanded to include Pseudomonas aeruginosa if the clinical response is disappointing or cultures grow P. aeruginosa 2.
- In cases of suppurative perichondritis, Pseudomonas aeruginosa is commonly found, and initial treatment should include anti-pseudomonal antibiotics 3.
- Oral antimicrobial agents such as ciprofloxacin and norfloxacin have been shown to be effective in the treatment of P. aeruginosa auricular perichondritis 4, 5.
Management of Perichondritis
The management of perichondritis can be divided into different stages based on the severity of the disease.
- Uncomplicated cases can be managed conservatively with antibiotics alone, resulting in no residual deformity 6.
- More severe cases may require incision and drainage or debridement, resulting in minor or gross residual deformity 6.
- In cases of perichondritis secondary to malignant otitis externa, wound debridement via a post-auricular approach can be effective, resulting in minor residual deformities 6.