From the Guidelines
For perichondritis, the preferred oral antibiotic is fluoroquinolone, specifically ciprofloxacin or levofloxacin, due to their effectiveness against Pseudomonas aeruginosa, a common causative organism in this condition. The choice of antibiotic is crucial in managing perichondritis, as it can help prevent cartilage destruction and deformity 1. When considering treatment options, it is essential to prioritize morbidity, mortality, and quality of life as outcomes. In this case, fluoroquinolone antibiotics, such as ciprofloxacin or levofloxacin, are recommended due to their broad-spectrum coverage, including Pseudomonas aeruginosa, which is often implicated in perichondritis, particularly following ear trauma or piercing 1. Some key points to consider when treating perichondritis include:
- The importance of prompt treatment to prevent cartilage destruction and deformity
- The use of fluoroquinolone antibiotics, such as ciprofloxacin or levofloxacin, as first-line treatment
- The potential need for alternative antibiotics, such as clindamycin, ceftazidime, and cefepime, in cases where the pathogen is resistant to fluoroquinolones or the patient has a contraindication to their use 1
- The role of surgical incision and drainage in cases where an abscess is present
- The use of warm compresses and anti-inflammatory medications as adjunctive therapy to help manage pain and inflammation. It is also important to note that treatment should be individualized based on the severity of the infection, the presence of any underlying medical conditions, and the patient's overall health status 1.
From the Research
Preferred Oral Antibiotics for Perichondritis
The preferred oral antibiotics for perichondritis, specifically for the treatment of Pseudomonas aeruginosa infections, include:
- Ciprofloxacin, a fluoroquinolone antibiotic, which has been shown to be effective in treating P. aeruginosa infections, including auricular perichondritis 2, 3, 4
- The use of ciprofloxacin is supported by studies demonstrating its efficacy in treating P. aeruginosa infections, with predicted cure rates of 0.91 and 0.72 for MICs of 0.5 and 1 microg/ml, respectively, with a PD-targeted regimen 4
Antibiotic Coverage for Non-Abscess Perichondritis
For non-abscess perichondritis, the preferred empirical treatment is intravenous antibiotic therapy covering Staphylococcus aureus, with expansion to include P. aeruginosa if the clinical response is disappointing or cultures grow P. aeruginosa 5
- This approach is supported by a study finding no significant differences in clinical progress, alteration in antibiotic therapy, duration of hospitalization, or frequency of relapse of infection or sequelae between patients treated with antibiotics covering S. aureus vs. P. aeruginosa 5
Considerations for Pediatric Patients
The use of fluoroquinolones, such as ciprofloxacin, in pediatric patients is a consideration due to potential safety concerns, and the latest evidence should be reviewed to determine the appropriateness of their use in this population 6