Treatment for Infected Ear Piercing
For infected ear piercings, remove the earring to allow drainage, clean the area, and apply topical antibiotics for mild infections, while fluoroquinolone antibiotics (such as ciprofloxacin or levofloxacin) should be used for cartilage infections due to risk of Pseudomonas aeruginosa. 1
Diagnosis and Assessment
- Distinguish between superficial skin infection and deeper perichondritis by checking for tenderness when deflecting the auricular cartilage - acute tenderness indicates deeper perichondrial infection 1
- Auricular perichondritis presents with painful swelling, warmth, and redness in a portion of the auricle that often spares the earlobe 2
- Most infections occur within the first month after piercing, especially during warm-weather months 2
- Common pathogens include Pseudomonas aeruginosa, Staphylococcus aureus, and Streptococcus pyogenes 2
Treatment Algorithm
For Minor Earlobe Infections:
- Remove the earring to prevent embedding and allow drainage 1
- Clean the affected area thoroughly 3
- Apply topical antibiotic (like bacitracin) 1-3 times daily 3
- May cover with a sterile bandage 3
- Monitor for 48 hours - if no improvement, escalate treatment 1
For Cartilage Infections (Perichondritis):
- Start fluoroquinolone antibiotic therapy (ciprofloxacin or levofloxacin) due to effectiveness against Pseudomonas aeruginosa 2, 4
- Alternative options for hospitalization include clindamycin, ceftazidime, and cefepime, depending on the pathogen 2
- If an abscess is present, surgical incision and drainage are necessary to prevent cartilage necrosis 2, 5
- Dual intravenous antibiotic therapy may be required for severe infections 5
Special Considerations
- For allergic reactions (43% of ear piercing complications), remove the earring and apply topical corticosteroids 2, 1
- Wait 6-8 weeks after complete resolution of infection before repiercing 2
- Upper ear cartilage piercings have significantly higher infection rates than earlobe piercings 6
- Clinicians should respond aggressively to potential auricular chondritis and consider Pseudomonas as a possible cause pending culture results 6
Warning Signs Requiring Urgent Care
- Spreading infection or systemic symptoms 1
- Formation of an abscess 2
- Failure to improve after 48 hours of appropriate antibiotic therapy 1
- Cosmetic deformity risk increases with delayed treatment 5
Common Pitfalls to Avoid
- Treating cartilage infections with antibiotics that don't cover Pseudomonas aeruginosa, which can lead to treatment failure and cosmetic deformity 1, 7
- Delaying removal of the earring in the presence of infection 1
- Failing to recognize perichondritis, which requires more aggressive treatment than simple earlobe infections 2
- Using spring-loaded piercing guns for cartilage piercings, which can damage cartilage and contribute to infection 7, 6