What is the treatment for an infected ear piercing in an 11-year-old?

Treatment of Infected Ear Piercing in an 11-Year-Old

For an infected ear piercing in an 11-year-old, the best treatment approach is to remove the earring, clean the area, and apply topical antibiotic therapy, with fluoroquinolone antibiotic eardrops (ofloxacin or ciprofloxacin-dexamethasone) being the preferred treatment for more significant infections, especially those involving the cartilage. 1, 2

Diagnosis and Assessment

• Determine if the infection is a superficial skin infection or deeper perichondritis by checking for tenderness when deflecting the auricular cartilage - acute tenderness indicates deeper perichondrial infection 1
• Auricular perichondritis typically presents with painful swelling, warmth, and redness that often spares the earlobe 2
• Most ear piercing 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 with hydrogen peroxide or warm water 2
• Apply topical antibiotic (such as bacitracin) 1-3 times daily 3
• Monitor for improvement within 48 hours 1

For More Significant Infections or Cartilage Involvement:

• Remove the earring 1
• For cartilage infections (auricular perichondritis), start fluoroquinolone antibiotic therapy (ciprofloxacin or levofloxacin) due to their effectiveness against Pseudomonas aeruginosa 2
• Topical antibiotic eardrops (ofloxacin or ciprofloxacin-dexamethasone) are superior to oral antibiotics for ear infections, with clinical cure rates of 77-96% compared to 30-67% with systemic antibiotics 2
• Apply antibiotic eardrops twice daily for up to 10 days 2
• "Pump" the tragus (flap of skin in front of the ear canal) after placing drops to help them penetrate 2
• Remove drainage with a cotton-tipped swab dipped in hydrogen peroxide or warm water 2

For Abscess Formation:

• Surgical incision and drainage are necessary to prevent cartilage necrosis 2
• After drainage, continue appropriate antibiotic therapy 2
• Be aware that once an abscess develops, good cosmetic preservation of the auricular cartilage is difficult to maintain 2

Special Considerations

• For allergic reactions (which occur in up to 43% of ear piercings), remove the earring and apply topical corticosteroids 2, 1
• Wait 6-8 weeks after complete resolution of infection and local swelling before repiercing 2
• Prevent water entry into the ear during bathing or hair washing by using cotton saturated with petroleum jelly to cover the opening until the infection resolves 2
• To avoid yeast infections of the ear canal, do not use antibiotic eardrops frequently or for more than 10 days at a time 2

Warning Signs Requiring Urgent Medical Attention

• Spreading infection or systemic symptoms 1
• Formation of an abscess 1
• Failure to improve after 48 hours of appropriate antibiotic therapy 1
• Ear drainage continuing for more than 7 days 2

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, 4
• Delaying removal of the earring in the presence of infection 1
• Failing to recognize perichondritis, which can lead to cartilage necrosis requiring debridement 4
• Using piercing guns for cartilage piercing, which can cause trauma and increase infection risk 4, 5
• Continuing to wear earrings during sleep, which may cause pressure sores or postauricular skin irritation 2

Remember that ear cartilage infections are more serious than earlobe infections and require prompt, appropriate treatment to prevent permanent deformity 6, 7.