What is the antibiotic of choice for perichondritis of the ear?

Antibiotic Treatment for Perichondritis of the Ear

Fluoroquinolones, specifically ciprofloxacin or levofloxacin, are the antibiotics of choice for perichondritis of the ear due to their excellent coverage of Pseudomonas aeruginosa, the most common pathogen in severe cases. 1

Pathogen Considerations

• Pseudomonas aeruginosa is the predominant pathogen in auricular perichondritis with abscess formation (found in 58-69% of cases) 2, 3
• Staphylococcus aureus is more commonly found in non-abscess perichondritis (49% of cases) 2
• Other less common pathogens include Streptococcus pyogenes 1

First-Line Treatment

• For outpatient treatment of mild to moderate perichondritis:

  • Oral fluoroquinolones (ciprofloxacin or levofloxacin) are the first-line therapy 1, 4
  • Ciprofloxacin dosing: 500-750 mg orally twice daily 4
  • Levofloxacin dosing: 500-750 mg orally once daily 1

• For severe perichondritis requiring hospitalization:

  • Intravenous fluoroquinolones (ciprofloxacin or levofloxacin) 1
  • Alternative options include ceftazidime or cefepime 1

Alternative Treatment Options

• For patients with beta-lactam allergy or contraindications to fluoroquinolones:
  • Clindamycin may be considered, particularly if S. aureus is suspected 1
  • For confirmed S. aureus in non-abscess perichondritis, anti-staphylococcal antibiotics may be sufficient 2

Clinical Presentation and Diagnosis

• Auricular perichondritis typically presents with:
  • Painful swelling, warmth, and redness of the auricle that spares the earlobe 1
  • Acute tenderness on deflecting the auricular cartilage (distinguishes from superficial skin infection) 1
  • Often occurs within the first month after ear piercing or trauma, especially during warm weather 1

Treatment Duration and Monitoring

• Treatment should continue for 7-10 days, or until clinical resolution 1
• Monitor for:
  • Resolution of pain, swelling, and erythema 1
  • Development of abscess, which would require surgical drainage 1, 5

Surgical Management

• Surgical incision and drainage are necessary if abscess is present 1, 5
• Once an abscess develops, good cosmetic preservation of the auricular cartilage is difficult to maintain 1
• Wide cartilage and subcutaneous tissue debridement with preservation of the helical rim may be required in severe cases 5

Special Considerations

• Diabetic patients with perichondritis may benefit from adjunctive hyperbaric oxygen therapy 6
• Prompt treatment is essential to prevent cartilage necrosis and permanent auricular deformity 5
• Recurrent or persistent perichondritis may require surgical intervention 5

Pitfalls to Avoid

• Delaying treatment can lead to cartilage necrosis and permanent deformity 1, 5
• Treating only with antibiotics that don't cover Pseudomonas when abscess is present 3
• Failing to consider surgical drainage when an abscess has formed 1, 5
• Using aminoglycoside-containing eardrops, which can cause ototoxicity if the tympanic membrane is perforated 1