What is the treatment for a child with perichondritis?

Treatment of Perichondritis in Children

Fluoroquinolone antibiotics (ciprofloxacin or levofloxacin) are the first-line treatment for auricular perichondritis in children due to their excellent coverage against Pseudomonas aeruginosa and Staphylococcus aureus, the most common causative pathogens. 1

Pathogen Considerations

The choice of antibiotic therapy should be guided by the most likely pathogens:

• Pseudomonas aeruginosa is the predominant organism in abscess-forming perichondritis (found in 69% of available isolates) 2
• Staphylococcus aureus is more common in non-abscess perichondritis cases (49%) 3

Treatment Algorithm

1. Initial Assessment and Antibiotic Selection

• Mild to Moderate Cases:

  • Oral fluoroquinolone therapy:
    • Ciprofloxacin 500-750mg orally twice daily OR
    • Levofloxacin 750mg orally daily
  • Duration: 7-10 days 1

• Severe Cases:

  • IV fluoroquinolone therapy:
    • Ciprofloxacin 400mg IV every 12 hours OR
    • Levofloxacin 750mg IV daily
  • Consider combination therapy for broader coverage 1

2. Alternative Antibiotic Options

If fluoroquinolones are contraindicated:

• Clindamycin (for S. aureus coverage)
• Ceftazidime (for P. aeruginosa coverage)
• Cefepime (for broader coverage) 1

3. Monitoring and Follow-up

• Reassess after 72 hours of antibiotic therapy
• If clinical improvement is observed, complete the 7-10 day course
• If poor response, consider:
  • Changing antibiotics based on culture results
  • Extending treatment duration
  • Surgical intervention 1

4. Surgical Management

• Surgery is indicated in approximately 7-31% of cases, particularly when an abscess is present 1
• Surgical intervention includes:
  • Incision and drainage of abscess
  • Debridement of necrotic tissue
  • Preservation of helical rim to minimize deformity 4

Important Considerations

• Early treatment is critical to prevent cartilage necrosis and permanent auricular deformity 5
• In non-abscess perichondritis cases, antibiotics covering S. aureus may be sufficient initial therapy, with expansion to cover P. aeruginosa if clinical response is poor 3
• For patients with abscess formation, P. aeruginosa is associated with more advanced clinical presentation and longer hospitalization 2

Potential Complications

• Cartilage necrosis
• Permanent auricular deformity ("cauliflower ear")
• Recurrent infection

Early and appropriate antibiotic therapy targeting the most likely pathogens is essential to prevent these complications and preserve normal ear structure and function.