Can we apply mupirocin on perichondritis?

Mupirocin Should NOT Be Applied for Perichondritis

Do not use mupirocin for auricular perichondritis—fluoroquinolone antibiotics (ciprofloxacin or levofloxacin) are the recommended treatment because the primary pathogen is Pseudomonas aeruginosa, against which mupirocin has poor activity. 1

Why Mupirocin is Inappropriate

• Mupirocin lacks adequate coverage for Pseudomonas aeruginosa, the most common pathogen in auricular perichondritis, along with Staphylococcus aureus and Streptococcus pyogenes 1
• Mupirocin has "less activity against other Gram-positive and most Gram-negative bacteria" beyond staphylococci and streptococci, making it ineffective for the polymicrobial nature of perichondritis 2
• Mupirocin is "moderately active against Gram-negative bacteria" at best, which is insufficient for treating Pseudomonas infections 3

Recommended Treatment for Perichondritis

First-Line Therapy

• Fluoroquinolone antibiotics are the treatment of choice: ciprofloxacin or levofloxacin provide excellent coverage against Pseudomonas aeruginosa, which "often respond well" to these agents 1
• Oral ciprofloxacin has been specifically demonstrated to successfully treat Pseudomonas aeruginosa auricular perichondritis as outpatient therapy 4

Alternative Options for Severe Cases

• For hospitalized patients requiring intravenous therapy, consider clindamycin, ceftazidime, or cefepime depending on the identified pathogen 1

Surgical Intervention When Needed

• If an abscess develops, surgical incision and drainage are necessary 1
• Once abscess formation occurs, preserving good cosmetic appearance of the auricular cartilage becomes difficult 1

Clinical Recognition of Perichondritis

• Perichondritis typically occurs within the first month after ear piercing, especially during warm weather 1
• Key clinical features include painful swelling, warmth, and redness affecting the auricle while characteristically sparing the earlobe 1
• Acute tenderness when deflecting the auricular cartilage distinguishes deeper perichondrial infection from superficial skin infection 1
• Minor infections can rapidly progress to perichondritis, abscess formation, and cartilage necrosis with or without systemic symptoms 1

When Mupirocin IS Appropriate

Mupirocin should be reserved for:

• Superficial staphylococcal and streptococcal skin infections like impetigo 5, 6
• Minor secondarily infected wounds or skin lesions 5
• Nasal decolonization for recurrent staph infections 5