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A previously-healthy 12-year old girl who was allowed to get a high cartilage ear piercing after much begging now comes in with evidence of infection around the piercing site. There is a small amount of purulent discharge. The piercing has been removed. The child is afebrile and nontoxic and there are no signs of infection spread such as mastoiditis, brain abscess, meningitis. You plan a trial of outpatient antibiotic therapy with close follow-up.
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February 6, 2024 at 2:01 pm
D) Ciprofloxacin
The main organisms of concern with perichondritis (ear cartilage infection) are pseudomonas and staph aureus. The drug of choice for outpatient treatment is ciprofloxacin. Inpatient treatment is not required given localized infection, no fever, no immunocompromise or other high risk factors. Close follow-up is warranted, however, in case of outpatient treatment failure. Although there are theoretical concerns regarding use of fluoroquinolones in children, they are not absolutely contraindicated, and should be used when they are the most appropriate choice and no alternative exists.