• 
• 

Three Part Question

In [adults with traumatic laceration of the pinna], do [prophylactic antibiotics after suturing] [help to prevent perichondritis]?

Clinical Scenario

An adult patient attends the ED with a simple traumatic laceration to the pinna after fighting. You have heard that we should give prophylactic antibiotics to these patients after suturing the wound as they have a high risk of developing perichondritis. You wonder whether there is any evidence for this.

Search Strategy

OVID MEDLINE (R) < 1946 to April Week 4 2012>


(pinna or (external adj ear) or auricle).mp or Ear Auricle/ and (injur* or lacerat* or trauma* or wound*).mp and (perichondritis or infect* or inflammat* or cartilage).mp and (antibiotic* or prophyla*).mp or exp Anti-Bacterial Agents/


Embase was searched from 1980 using the same terms, as was the Cochrane Library.

Search Outcome

The Medline search produced 26 citations, none of which directly answered the question. One review was found that provided some useful information.

The search of Embase found the same review and an analysis of 114 cases of perichondritis. Searching the Cochrane Library did not yield any other references.

Relevant Paper(s)

Author, date and country	Patient group	Study type (level of evidence)	Outcomes	Key results	Study Weaknesses

Comment(s)

Although there are no randomised controlled trials that directly answer the question, one retrospective clinical trial (Prasad et al) found trauma (mostly ear piercing and haematoma) to be the cause of perichondritis in 46% of cases (61 patients over a 5-year period). Nineteen of these patients were managed conservatively with antibiotics without any residual scarring. In this series and another of 114 patients (Davidi et al) the commonest organism isolated was Pseudomonas aeruginosa. So, although no studies discuss the use of prophylactic antibiotics in these patients, if an antibiotic were to be used then it would be reasonable to use one with good cover for Psuedomonas.

Clinical Bottom Line

Local advice should be followed.

References

1. Prasad HK, Sreedharan S, Prasad HS, et al. Perichondritis of the auricle and its management Journal of Laryngology and Otology 2007, 121(6):530-534.
2. Davidi E, Paz A, Duchman H, et al. Perichondritis of the auricle: analysis of 114 cases. Israel Medical Association Journal 2011, 13(1):21-4.