Treatment of Perichondritis
For auricular perichondritis, oral fluoroquinolones (ciprofloxacin or levofloxacin) are the first-line treatment for mild to moderate cases, while severe cases requiring hospitalization should receive intravenous fluoroquinolones, with treatment duration of 7-10 days or until clinical resolution. 1
Initial Antibiotic Selection
Mild to Moderate Cases (Outpatient)
- Oral fluoroquinolones are first-line therapy: 1
- These agents effectively cover Pseudomonas aeruginosa, which is the predominant pathogen in severe cases (58% of abscess cases) 2, 3
Severe Cases (Hospitalization Required)
- Intravenous fluoroquinolones (ciprofloxacin or levofloxacin) are recommended 1
- Hospitalization is indicated for patients with advanced clinical presentation, systemic toxicity, or abscess formation 2, 3
Alternative Pathogen Considerations
Recent evidence challenges the universal need for anti-pseudomonal coverage in non-abscess perichondritis. 2 In non-abscess cases, Staphylococcus aureus was the predominant pathogen (49% of cases), while P. aeruginosa was found in only a minority 2. However, given the serious consequences of inadequate treatment and the traditional guideline recommendations, fluoroquinolones remain the safest initial choice 1.
Alternative Regimens
- Clindamycin may be considered for patients with beta-lactam allergy or fluoroquinolone contraindications, particularly when S. aureus is suspected 1
- If clinical response to anti-staphylococcal therapy is disappointing, expand coverage to include P. aeruginosa 2
Treatment Duration and Monitoring
- Continue treatment for 7-10 days or until clinical resolution 1
- Monitor specifically for:
Surgical Management
Surgical incision and drainage are mandatory if abscess develops. 1 The presence of abscess significantly changes management:
- Abscess formation requires immediate surgical drainage 1, 4
- Wide cartilage and subcutaneous tissue debridement may be necessary for persistent cases 4
- Preservation of the helical rim minimizes resulting auricular deformity 4
- Good cosmetic preservation is difficult once abscess has formed 1
Adjunctive Therapy
- Nonsteroidal anti-inflammatory drugs should be added for symptomatic relief 4
- For diabetic patients with recurrent or refractory perichondritis, hyperbaric oxygen therapy may be beneficial as adjunctive treatment 5
Critical Pitfalls to Avoid
- Delaying treatment leads to cartilage necrosis and permanent deformity 1
- Failing to recognize abscess formation requiring surgical drainage 1
- Using aminoglycoside-containing eardrops if tympanic membrane perforation is present (causes ototoxicity) 1
- Inadequate treatment duration—stopping antibiotics before complete clinical resolution 1
Clinical Recognition
Perichondritis presents with painful swelling, warmth, and redness of the auricle that characteristically spares the earlobe 1. Acute tenderness on deflecting the auricular cartilage distinguishes it from superficial skin infection 1. It commonly occurs within the first month after ear piercing or trauma, especially during warm weather 1.