From the Guidelines
For perichondritis, the recommended oral antibiotic regimen is fluoroquinolones, with ciprofloxacin or levofloxacin being the first-line treatment, as they provide good coverage against Pseudomonas aeruginosa, S aureus, and S pyogenes, the most common pathogens involved in this condition. The choice of antibiotic is crucial in managing perichondritis, as minor infections can progress to perichondritis, abscess formation, and necrosis with or without systemic symptoms 1. Some key points to consider when treating perichondritis include:
- The use of fluoroquinolone antibiotic treatment, such as ciprofloxacin or levofloxacin, which often respond well to these pathogens 1
- Alternative options, such as clindamycin, ceftazidime, and cefepime, may be considered for hospitalization, depending on the pathogen 1
- The importance of prompt treatment to prevent cartilage destruction and deformity
- The need for reevaluation if there is no improvement within 48-72 hours, or if there is significant swelling, fluctuance, or systemic symptoms, as the patient may require intravenous antibiotics or surgical drainage
- The use of warm compresses and anti-inflammatory medications as adjunctive therapy to help manage pain and inflammation.
From the Research
Recommended Course of Oral Antibiotics for Perichondritis
The recommended course of oral antibiotics for perichondritis (inflammation of the cartilage) can vary depending on the causative pathogen and the severity of the infection.
- For non-abscess perichondritis, empirical treatment with antibiotics covering Staphylococcus aureus is sufficient and appropriate in the majority of patients 2.
- If the clinical response is disappointing or cultures grow Pseudomonas aeruginosa, antibiotic coverage should be expanded to include P. aeruginosa 2.
- Oral ciprofloxacin has been shown to be effective in the treatment of Pseudomonas aeruginosa auricular perichondritis 3.
- Levofloxacin, a fluoroquinolone antibacterial agent, has a broad spectrum of activity against Gram-positive and Gram-negative bacteria and atypical respiratory pathogens, and may be used as an alternative to ciprofloxacin 4.
- The choice of antibiotic and duration of treatment should be guided by the severity of the infection, the presence of abscess or effusion, and the patient's clinical response to treatment 5, 6.
Key Considerations
- The most common pathogens involved in perichondritis are Staphylococcus aureus and Pseudomonas aeruginosa 2, 3, 6.
- Antibiotic treatment should be initiated promptly to avoid necrosis of the underlying avascular cartilage and auricular deformity 5.
- The duration of treatment may vary depending on the severity of the infection and the patient's clinical response, but typically ranges from 7-14 days 6, 4.