Pinna cellulitis / perichondritis

Including complications of piercings or otitis externa.

Treat for 5 days. Can be extended to 7 days, depending on severity and response to treatment.

Consider Delabelling of spurious penicillin allergy in patients who are low risk and are clinically stable.

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Preferred

flucloxacillin 1g po qds. For severe infection: flucloxacillin 1g iv qds (increase to 2g iv qds in obese patients)

Alternative

Non-severe penicillin allergy: cefalexin 1g po tds

Severe penicillin allergy: doxycycline 100mg po bd

For MRSA positive patients: co-trimoxazole 960mg po bd (iv if NBM)

For penicillin allergy (severe or non-severe) and not able to take oral medication: clarithromycin 500mg po bd iv

Preferred, including penicillin allergy non-severe

ceftazidime 2g iv tds (or 3g iv bd for OPAT)

Note: if patient is over 80 years of age the usual daily maximum dose of ceftazidime is 3g; this can be increased to 6g daily on advice documented by ID Micro Consultant

Review iv daily and switch to oral when possible: ciprofloxacin* 750mg po bd

For penicillin allergy (severe)

ciprofloxacin* 750mg po bd (400mg iv bd if NBM)

*Ensure that the patient is given the Fluoroquinolone MHRA patient information leaflet. Fluoroquinolones, including ciprofloxacin are associated with disabling and potentially long-lasting or irreversible side effects. See Fluoroquinolone antibiotics - severe adverse effects.

Pinna cellulitis WITHOUT piercing involvement, and NO evidence of perichondritis and NO evidence of Pseudomonas aeruginosa

Pinna cellulitis WITH piercing involvement OR evidence of perichondritis OR Pseudomonas aeruginosa on culture

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