B is the correct answer. Why?

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A Cephalexin
B Ciprofloxacin and mupirocin
C Clindamycin
D Vancomycin and cefepime


Perichondritis is an infection of the cartilage of the ear. It is commonly caused by trauma, with ear piercings as a common etiology. Patients will present with erythema, swelling, and severe pain to palpation and manipulation of the ear. The diagnosis can be made clinically. The most common causative organisms of perichondritis include Pseudomonas aeruginosa, Staphylococcus aureus, and Streptococcus pyogenes. Outbreaks of P. aeruginosaperichondritis have been associated with spring-loaded piercing guns. Treatment is commonly a fluoroquinolone (such as ciprofloxacin) as well as consideration of coverage for Staphylococcus aureus (such as mupirocin). Piercings should be removed, and aftercare solutions should be stopped due to previous reports of bacterial contamination. Early, appropriate treatment mitigates complications such as abscess, necrosis, and poor cosmetic appearance caused by the infection.

Cephalexin (A) is an appropriate antibiotic for cellulitis, which presents with erythema, warmth, and tenderness of the skin. It does not cover for Pseudomonas aeruginosa. Perichondritis is often confused for cellulitis, thus close attention to symptoms and physical exam is essential to differentiate the two. Since perichondritis affects the cartilage, infection usually spares the ear lobule. Cellulitis typically involves the lobule.

Clindamycin (C) concentrates in the cartilage of the ear and offers appropriate coverage of methicillin-resistant Staphylococcus aureus (MRSA) that might be present with severe cellulitis. However, it does not offer coverage for Pseudomonas aeruginosa, which is the most common organism involved in perichondritis.

Vancomycin and cefepime (D) is appropriate coverage of severe perichondritis and includes coverage for both MRSA and Pseudomonas aeruginosa. These are both intravenous medications and would be reserved for severe infections, including systemic symptoms, abscesses, and necrosis.

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