Lymphangitis medical therapy: Difference between revisions
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__NOTOC__ | __NOTOC__ | ||
{{Lymphangitis}} | {{Lymphangitis}} | ||
{{CMG}}; {{AE}} {{VR}},{{Faizan}}{{VD}} | |||
{{CMG}}; {{AE}} {{VR}} | |||
==Overview== | ==Overview== | ||
Lymphangitis | Lymphangitis being a manifestation of wide concurrently occurring spectrum of manifestations or pathologies.The medical therapy varies from etiology to etiology. The mainstay of therapy for lymphangitis of infectious origin is antimicrobial therapy. Supportive therapy includes [[analgesics]], [[anti-inflammatory]] agents, and warm compresses. Specific anitmicrobial treatment for individual infections are discussed in detail separately. | ||
==Medical Therapy== | |||
== | The mainstay of therapy for lymphangitis of infectious origin is antimicrobial therapy. Supportive therapy includes [[analgesics]], [[anti-inflammatory]] agents, and warm compresses. | ||
= | <ref name="lymphangitis">lymphanitis Mandell, GERALD L. "Mandell, Douglas, and Bennett's." Principles and practice of infectious diseases 7 (1995) Accessed on October 12,2016</ref> | ||
=== | ====Lymphangitis of infectious etiology==== | ||
====Empiric Therapy==== | Common preferred and accepted therapy for lymphangitis of infectious origin include: Dicloxacillin or Cephalexin | ||
< | ::* Preferred regimen: [[Dicloxacillin]] | ||
::* Preferred regimen: [[Cephalexin]] 500 mg PO qid for 1 week | |||
:*2. '''Patient with lymphangitis and if Community-Associated Methicillin-Resistant Staphylococcus Aureus (CA-MRSA) suspected''': | |||
::* [[Trimethoprim-sulfamethoxazole]] PO bid {{and}} vancomycin 1 g IV every 12 hr | |||
:* 3.'''Patient with lymphangitis allergic to penicillin''': | |||
::* [[Clindamycin]] 300 mg PO qid for 7 days {{or}} [[Erythromycin]] 500 mg PO qid for 7 days {{or}} [[Levofloxacin]] 500 mg PO daily {{or}} [[Moxifloxacin]] 400 mg PO daily for 7 days. | |||
====Empiric Therapy <small><small><small> ''Adapted from Mandell, Douglas, and Bennett's Principles and Practice of Infectious Diseases.''<ref name="Mandell">{{Cite book | last1 = Mandell | first1 = Gerald L. | last2 = Bennett | first2 = John E. (John Eugene) | last3 = Dolin | first3 = Raphael. | title = Mandell, Douglas, and Bennett's principles and practice of infectious disease | date = 2010 | publisher = Churchill Livingstone/Elsevier | location = Philadelphia, PA | isbn = | pages = }}</ref>''Adapted from Clin Infect Dis. 2005 Nov 15;41(10):1373-406.''<ref name="pmid16231249">{{cite journal| author=Stevens DL, Bisno AL, Chambers HF, Everett ED, Dellinger P, Goldstein EJ et al.| title=Practice guidelines for the diagnosis and management of skin and soft-tissue infections. | journal=Clin Infect Dis | year= 2005 | volume= 41 | issue= 10 | pages= 1373-406 | pmid=16231249 | doi=10.1086/497143 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16231249 }} </ref> ''J Emerg Med. 2013 Jun;44(6):e397-412.''<ref name="pmid23466022">{{cite journal| author=Moran GJ, Abrahamian FM, Lovecchio F, Talan DA| title=Acute bacterial skin infections: developments since the 2005 Infectious Diseases Society of America (IDSA) guidelines. | journal=J Emerg Med | year= 2013 | volume= 44 | issue= 6 | pages= e397-412 | pmid=23466022 | doi=10.1016/j.jemermed.2012.11.050 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23466022 }} </ref>''Clin Infect Dis. 2011 Feb 1;52(3):e18-55.''<ref name="pmid21208910">{{cite journal| author=Liu C, Bayer A, Cosgrove SE, Daum RS, Fridkin SK, Gorwitz RJ et al.| title=Clinical practice guidelines by the infectious diseases society of america for the treatment of methicillin-resistant Staphylococcus aureus infections in adults and children. | journal=Clin Infect Dis | year= 2011 | volume= 52 | issue= 3 | pages= e18-55 | pmid=21208910 | doi=10.1093/cid/ciq146 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21208910 }} </ref></small></small></small>==== | |||
<SMALL><font color="#FF4C4C">'''▸ Click on the following categories to expand treatment regimens.'''</font></SMALL> | |||
{| | {| | ||
| valign=top | | | valign=top | | ||
<div style="border-radius: 5px 5px 0 0; border: solid 1px #20538D; border-bottom: 0px; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 30px; line-height: 30px; width: | <div style="border-radius: 5px 5px 0 0; border: solid 1px #20538D; border-bottom: 0px; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 30px; line-height: 30px; width: 320px; background: #A1BCDD; text-align: center;"> | ||
<font color="#FFF"> | <font color="#FFF"> | ||
'''Mild - Moderate Acute Lymphangitis''' | '''Mild - Moderate Acute Lymphangitis''' | ||
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</div> | </div> | ||
<div class="mw-customtoggle-table01" style="cursor: pointer; border-radius: 0 0 0 0; border: solid 1px #20538D; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 30px; line-height: 30px; width: | <div class="mw-customtoggle-table01" style="cursor: pointer; border-radius: 0 0 0 0; border: solid 1px #20538D; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 30px; line-height: 30px; width: 320px; background: #4479BA;"> | ||
<font color="#FFF"> | <font color="#FFF"> | ||
▸ '''Adults''' | ▸ '''Adults''' | ||
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</div> | </div> | ||
<div class="mw-customtoggle-table02" style="cursor: pointer; border-radius: 0 0 0 0; border: solid 1px #20538D; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 30px; line-height: 30px; width: | <div class="mw-customtoggle-table02" style="cursor: pointer; border-radius: 0 0 0 0; border: solid 1px #20538D; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 30px; line-height: 30px; width: 320px; background: #4479BA;"> | ||
<font color="#FFF"> | <font color="#FFF"> | ||
▸ '''Children age >28 days''' | ▸ '''Children age >28 days''' | ||
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</div> | </div> | ||
<div style="border-radius: | <div style="border-radius: 0 0 0 0; border: solid 1px #20538D; border-bottom: 0px; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 30px; line-height: 30px; width: 320px; background: #A1BCDD; text-align: center;"> | ||
<font color="#FFF"> | <font color="#FFF"> | ||
'''Severe Acute Lymphangitis''' | '''Severe Acute Lymphangitis''' | ||
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</div> | </div> | ||
<div class="mw-customtoggle-table03" style="cursor: pointer; border-radius: 0 0 0 0; border: solid 1px #20538D; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 30px; line-height: 30px; width: | <div class="mw-customtoggle-table03" style="cursor: pointer; border-radius: 0 0 0 0; border: solid 1px #20538D; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 30px; line-height: 30px; width: 320px; background: #4479BA;"> | ||
<font color="#FFF"> | <font color="#FFF"> | ||
▸ '''Adults''' | ▸ '''Adults''' | ||
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</div> | </div> | ||
<div class="mw-customtoggle-table04" style="cursor: pointer; border-radius: 0 0 5px 5px; border: solid 1px #20538D; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 30px; line-height: 30px; width: | <div class="mw-customtoggle-table04" style="cursor: pointer; border-radius: 0 0 5px 5px; border: solid 1px #20538D; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 30px; line-height: 30px; width: 320px; background: #4479BA;"> | ||
<font color="#FFF"> | <font color="#FFF"> | ||
▸ '''Children age >28 days''' | ▸ '''Children age >28 days''' | ||
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| style="padding: 0 5px; font-size: 90%; background: #F5F5F5;" align=center | '''''For Suspected Methicillin-Resistant Staphylococcus Aureus (MRSA)''''' | | style="padding: 0 5px; font-size: 90%; background: #F5F5F5;" align=center | '''''For Suspected Methicillin-Resistant Staphylococcus Aureus (MRSA)''''' | ||
|- | |- | ||
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | ▸ '''''[[Clindamycin]] 300-450 mg PO q8h'''''<BR> OR <BR>▸ '''''[[TMP-SMX]] 1 or 2 double-strength tablets ( | | style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | ▸ '''''[[Clindamycin]] 300-450 mg PO q8h'''''<BR> OR <BR>▸ '''''[[TMP-SMX]] 1 or 2 double-strength tablets (160/800 mg) PO q12h'''''<BR> OR <BR>▸ '''''[[Doxycycline]] 100 mg PO q12h'''''<BR> OR <BR> ▸ '''''[[Minocycline]] 100 mg PO q12h'''''<BR> OR <BR> ▸ '''''[[Linezolid]] 600 mg PO q12h''''' | ||
|- | |- | ||
| style="padding: 0 5px; font-size: 90%; background: #F5F5F5;" align=center | '''''For Suspected Beta-Hemolytic Streptococci and Methicillin-Resistant Staphylococcus Aureus (MRSA)''''' | | style="padding: 0 5px; font-size: 90%; background: #F5F5F5;" align=center | '''''For Suspected Beta-Hemolytic Streptococci and Methicillin-Resistant Staphylococcus Aureus (MRSA)''''' | ||
|- | |- | ||
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | ▸ '''''[[Clindamycin]] 300-450 mg PO q8h''''' | | style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | ▸ '''''[[Clindamycin]] 300-450 mg PO q8h''''' | ||
|- | |||
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | OR | |||
|- | |||
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | ▸ '''''[[Amoxicillin]] 500 mg PO q8h'''''<BR> PLUS <BR> ▸ '''''[[TMP-SMX]] 1 or 2 double-strength tablets (sulfamethoxazole 800 mg; trimethoprim 160 mg) PO q12h'''''<BR> OR <BR> ▸ '''''[[Doxycycline]] 100 mg PO q12h'''''<BR> OR <BR> ▸ '''''[[Minocycline]] 100 mg PO q12h''''' | |||
|- | |||
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | OR | |||
|- | |||
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left |▸ '''''[[Linezolid]] 600 mg PO q12h''''' | |||
|- | |- | ||
| style="padding: 0 5px; font-size: 90%; background: #F5F5F5;" align=center | '''''For Animal Bites''''' | | style="padding: 0 5px; font-size: 90%; background: #F5F5F5;" align=center | '''''For Animal Bites''''' | ||
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|} | |} | ||
|} | |} | ||
{| class="mw-collapsible mw-collapsed" id="mw-customcollapsible-table02" style="background: #FFFFFF;" | {| class="mw-collapsible mw-collapsed" id="mw-customcollapsible-table02" style="background: #FFFFFF;" | ||
| valign=top | | | valign=top | | ||
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| style="padding: 0 5px; font-size: 90%; background: #F5F5F5;" align=center | '''''Preferred Regimen''''' | | style="padding: 0 5px; font-size: 90%; background: #F5F5F5;" align=center | '''''Preferred Regimen''''' | ||
|- | |- | ||
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | ▸ '''''[[Penicillin V]] 500 mg PO | | style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | ▸ '''''[[Penicillin V]] < 12 years-old 25-50 mg/kg/day PO divided q6-8h (maximum 3 g/day), > 12 years-old 250-500 mg PO q6-8h''''' | ||
|- | |- | ||
| style="padding: 0 5px; font-size: 90%; background: #F5F5F5;" align=center | '''''Alternative Regimen''''' | | style="padding: 0 5px; font-size: 90%; background: #F5F5F5;" align=center | '''''Alternative Regimen''''' | ||
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| style="padding: 0 5px; font-size: 90%; background: #F5F5F5;" align=center | '''''For Suspected Methicillin-Resistant Staphylococcus Aureus (MRSA)''''' | | style="padding: 0 5px; font-size: 90%; background: #F5F5F5;" align=center | '''''For Suspected Methicillin-Resistant Staphylococcus Aureus (MRSA)''''' | ||
|- | |- | ||
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | ▸ '''''[[Clindamycin]] 10-13 mg/kg PO q6-8h'''''<BR> OR <BR> ▸ '''''[[TMP-SMX]] 8–12 mg/kg (based on trimethoprim component) PO q12h'''''<BR> OR <BR> ▸ '''''[[Doxycycline]] ≤45 kg: 2 mg/kg PO q12h; >45 kg: 100 mg PO q12h'''''<BR> OR <BR> ▸ '''''[[Minocycline]] 2 mg/kg PO q12h'''''<BR> OR <BR> ▸ '''''[[Linezolid]] 10 mg/kg PO q8h''''' | | style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | ▸ '''''[[Clindamycin]] 10-13 mg/kg PO q6-8h'''''<BR> OR <BR> ▸ '''''[[TMP-SMX]] 8–12 mg/kg (based on trimethoprim component) PO q12h'''''<BR> OR <BR> ▸ '''''[[Doxycycline]]¶ ≤45 kg: 2 mg/kg PO q12h; >45 kg: 100 mg PO q12h'''''<BR> OR <BR> ▸ '''''[[Minocycline]] 2 mg/kg PO q12h ¶'''''<BR> OR <BR> ▸ '''''[[Linezolid]] 10 mg/kg PO q8h''''' | ||
|- | |||
| style="padding: 0 5px; font-size: 90%; background: #F5F5F5" align=left | <SMALL><sup>¶</sup> Not recommended for children < 8 years of age </small> | |||
|- | |- | ||
| style="padding: 0 5px; font-size: 90%; background: #F5F5F5;" align=center | '''''For Suspected Beta-Hemolytic Streptococci and Methicillin-Resistant Staphylococcus Aureus (MRSA)''''' | | style="padding: 0 5px; font-size: 90%; background: #F5F5F5;" align=center | '''''For Suspected Beta-Hemolytic Streptococci and Methicillin-Resistant Staphylococcus Aureus (MRSA)''''' | ||
|- | |- | ||
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | | |- | ||
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left |'''''[[Clindamycin]] 10-13 mg/kg IV q6-8h''''' | |||
|- | |||
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | OR | |||
|- | |||
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | ▸ '''''[[Amoxicillin]] 500 mg PO q8h'''''<BR> PLUS <BR> ▸ '''''[[TMP-SMX]] 8–12 mg/kg (based on trimethoprim component) PO q12h'''''<BR> OR <BR> ▸ '''''[[Doxycycline]]¶ ≤45 kg: 2 mg/kg PO q12h; >45 kg: 100 mg PO q12h'''''<BR> OR <BR> ▸ '''''[[Minocycline]]¶ 2 mg/kg PO q12h''''' | |||
|- | |||
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | OR | |||
|- | |||
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left |▸ '''''[[Linezolid]] 10 mg/kg PO q8h''''' | |||
|- | |||
|- | |||
| style="padding: 0 5px; font-size: 90%; background: #F5F5F5" align=left | <SMALL><sup>¶</sup> Not recommended for children < 8 years of age </small> | |||
|- | |||
|- | |- | ||
| style="padding: 0 5px; font-size: 90%; background: #F5F5F5;" align=center | '''''For Animal Bites''''' | | style="padding: 0 5px; font-size: 90%; background: #F5F5F5;" align=center | '''''For Animal Bites''''' | ||
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| style="padding: 0 5px; font-size: 90%; background: #F5F5F5;" align=center | '''''For Suspected Methicillin-Sensitive Staphylococcus Aureus (MSSA)''''' | | style="padding: 0 5px; font-size: 90%; background: #F5F5F5;" align=center | '''''For Suspected Methicillin-Sensitive Staphylococcus Aureus (MSSA)''''' | ||
|- | |- | ||
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | ▸ '''''[[Nafcillin]] 1-2 g IV q4h'''''<BR> OR <BR> ▸ '''''[[Oxacillin]] 1-2 g IV q4h'''''<BR> OR <BR> ▸ '''''[[Cefazolin]] 1 g IV q8h'''''<BR> OR <BR> ▸ '''''[[Clindamycin]] 300-450 mg PO q8h | | style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | ▸ '''''[[Nafcillin]] 1-2 g IV q4h'''''<BR> OR <BR> ▸ '''''[[Oxacillin]] 1-2 g IV q4h'''''<BR> OR <BR> ▸ '''''[[Cefazolin]] 1 g IV q8h'''''<BR> OR <BR> ▸ '''''[[Clindamycin]] 300-450 mg PO q8h''''' | ||
|- | |- | ||
| style="padding: 0 5px; font-size: 90%; background: #F5F5F5;" align=center | '''''For Suspected Methicillin-Resistant Staphylococcus Aureus (MRSA)''''' | | style="padding: 0 5px; font-size: 90%; background: #F5F5F5;" align=center | '''''For Suspected Methicillin-Resistant Staphylococcus Aureus (MRSA)''''' | ||
|- | |- | ||
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | ▸ '''''[[Vancomycin]] 15-20 mg/kg IV q8-12h'''''<BR> OR <BR> ▸ '''''[[Linezolid]] 600 mg IV q12h'''''<BR> OR <BR> ▸ '''''[[Daptomycin]] 4mg/kg IV q24h '''''<BR> OR <BR> ▸ '''''[[Clindamycin]] 600 mg IV/PO q8h'''''<BR> OR <BR> ▸ '''''[[Telavancin]] 10 mg/kg IV q12h''''' | | style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | ▸ '''''[[Vancomycin]] 15-20 mg/kg IV q8-12h'''''<BR> OR <BR> ▸ '''''[[Linezolid]] 600 mg IV/PO q12h'''''<BR> OR <BR> ▸ '''''[[Daptomycin]] 4mg/kg IV q24h '''''<BR> OR <BR> ▸ '''''[[Clindamycin]] 600 mg IV/PO q8h'''''<BR> OR <BR> ▸ '''''[[Telavancin]] 10 mg/kg IV q12h''''' | ||
|- | |- | ||
| style="padding: 0 5px; font-size: 90%; background: #F5F5F5;" align=center | '''''For Suspected Beta-Hemolytic Streptococci and Methicillin-Resistant Staphylococcus Aureus (MRSA)''''' | | style="padding: 0 5px; font-size: 90%; background: #F5F5F5;" align=center | '''''For Suspected Beta-Hemolytic Streptococci and Methicillin-Resistant Staphylococcus Aureus (MRSA)''''' | ||
|- | |- | ||
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | ▸ '''''[[Clindamycin]] | | style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | ▸ '''''[[Clindamycin]] 600 mg IV/PO q8h'''''<BR> OR <BR> ▸ '''''[[Linezolid]] 600 mg IV/PO q12h''''' | ||
|- | |- | ||
| style="padding: 0 5px; font-size: 90%; background: #F5F5F5;" align=center | '''''For Animal Bites''''' | | style="padding: 0 5px; font-size: 90%; background: #F5F5F5;" align=center | '''''For Animal Bites''''' | ||
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| style="padding: 0 5px; font-size: 90%; background: #F5F5F5;" align=center | '''''For Suspected Beta-Hemolytic Streptococci and Methicillin-Resistant Staphylococcus Aureus (MRSA)''''' | | style="padding: 0 5px; font-size: 90%; background: #F5F5F5;" align=center | '''''For Suspected Beta-Hemolytic Streptococci and Methicillin-Resistant Staphylococcus Aureus (MRSA)''''' | ||
|- | |- | ||
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | | | style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left |'''''[[Clindamycin]] 10-13 mg/kg IV/PO q6-8h''''' <BR> OR <BR> ▸'''''[[Linezolid]] 10 mg/kg IV/PO q8h''''' | ||
|- | |- | ||
| style="padding: 0 5px; font-size: 90%; background: #F5F5F5;" align=center | '''''For Animal Bites''''' | | style="padding: 0 5px; font-size: 90%; background: #F5F5F5;" align=center | '''''For Animal Bites''''' | ||
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|} | |} | ||
====Pathogen Based Therapy==== | ====Pathogen Based Therapy <small><small><small> ''Adapted from Clin Infect Dis. 2005 Nov 15;41(10):1373-406.''<ref name="pmid16231249">{{cite journal| author=Stevens DL, Bisno AL, Chambers HF, Everett ED, Dellinger P, Goldstein EJ et al.| title=Practice guidelines for the diagnosis and management of skin and soft-tissue infections. | journal=Clin Infect Dis | year= 2005 | volume= 41 | issue= 10 | pages= 1373-406 | pmid=16231249 | doi=10.1086/497143 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16231249 }} </ref> ''J Emerg Med. 2013 Jun;44(6):e397-412.''<ref name="pmid23466022">{{cite journal| author=Moran GJ, Abrahamian FM, Lovecchio F, Talan DA| title=Acute bacterial skin infections: developments since the 2005 Infectious Diseases Society of America (IDSA) guidelines. | journal=J Emerg Med | year= 2013 | volume= 44 | issue= 6 | pages= e397-412 | pmid=23466022 | doi=10.1016/j.jemermed.2012.11.050 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23466022 }} </ref>''Clin Infect Dis. 2011 Feb 1;52(3):e18-55.''<ref name="pmid21208910">{{cite journal| author=Liu C, Bayer A, Cosgrove SE, Daum RS, Fridkin SK, Gorwitz RJ et al.| title=Clinical practice guidelines by the infectious diseases society of america for the treatment of methicillin-resistant Staphylococcus aureus infections in adults and children. | journal=Clin Infect Dis | year= 2011 | volume= 52 | issue= 3 | pages= e18-55 | pmid=21208910 | doi=10.1093/cid/ciq146 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21208910 }} </ref></small></small></small>==== | ||
<SMALL><font color="#FF4C4C">'''▸ Click on the following categories to expand treatment regimens.'''</font | <SMALL><font color="#FF4C4C">'''▸ Click on the following categories to expand treatment regimens.'''</font></SMALL> | ||
{| | {| | ||
| valign=top | | | valign=top | | ||
<div style="border-radius: 5px 5px 0 0; border: solid 1px #20538D; border-bottom: 0px; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 30px; line-height: 30px; width: | <div style="border-radius: 5px 5px 0 0; border: solid 1px #20538D; border-bottom: 0px; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 30px; line-height: 30px; width: 320px; background: #A1BCDD; text-align: center;"> | ||
<font color="#FFF"> | <font color="#FFF"> | ||
'''Bacteria''' | '''Bacteria''' | ||
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</div> | </div> | ||
<div class="mw-customtoggle-table05" style="cursor: pointer; border-radius: 0 0 0 0; border: solid 1px #20538D; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 30px; line-height: 30px; width: | <div class="mw-customtoggle-table05" style="cursor: pointer; border-radius: 0 0 0 0; border: solid 1px #20538D; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 30px; line-height: 30px; width: 320px; background: #4479BA;"> | ||
<font color="#FFF"> | <font color="#FFF"> | ||
▸ '''Streptococcus Pyogenes''' | ▸ '''Streptococcus Pyogenes''' | ||
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</div> | </div> | ||
<div class="mw-customtoggle-table06" style="cursor: pointer; border-radius: 0 0 0 0; border: solid 1px #20538D; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 30px; line-height: 30px; width: | <div class="mw-customtoggle-table06" style="cursor: pointer; border-radius: 0 0 0 0; border: solid 1px #20538D; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 30px; line-height: 30px; width: 320px; background: #4479BA;"> | ||
<font color="#FFF"> | <font color="#FFF"> | ||
▸ '''Methicillin Sensitive Staphylococcus Aureus''' | ▸ '''Methicillin Sensitive Staphylococcus Aureus''' | ||
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</div> | </div> | ||
<div class="mw-customtoggle-table07" style="cursor: pointer; border-radius: 0 0 0 0; border: solid 1px #20538D; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 30px; line-height: 30px; width: | <div class="mw-customtoggle-table07" style="cursor: pointer; border-radius: 0 0 0 0; border: solid 1px #20538D; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 30px; line-height: 30px; width: 320px; background: #4479BA;"> | ||
<font color="#FFF"> | <font color="#FFF"> | ||
▸ '''Methicillin Resistant Staphylococcus Aureus''' | ▸ '''Methicillin Resistant Staphylococcus Aureus''' | ||
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</div> | </div> | ||
<div class="mw-customtoggle-table08" style="cursor: pointer; border-radius: 0 0 5px 5px; border: solid 1px #20538D; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 30px; line-height: 30px; width: | <div class="mw-customtoggle-table08" style="cursor: pointer; border-radius: 0 0 5px 5px; border: solid 1px #20538D; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 30px; line-height: 30px; width: 320px; background: #4479BA;"> | ||
<font color="#FFF"> | <font color="#FFF"> | ||
▸ '''Pasteurella Multocida''' | ▸ '''Pasteurella Multocida''' | ||
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| style="padding: 0 5px; font-size: 90%; background: #F5F5F5;" align=left | '''''Adults''''' | | style="padding: 0 5px; font-size: 90%; background: #F5F5F5;" align=left | '''''Adults''''' | ||
|- | |- | ||
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | ▸ '''''[[Vancomycin]] 30 mg/kg IV q12h'''''<BR> OR <BR> ▸ '''''[[Linezolid]] 600 mg IV/PO q12h'''''<BR> OR <BR> ▸ '''''[[Clindamycin]] 300-450 mg PO q8h or 600 mg/kg IV q8h'''''<BR> OR <BR> ▸ '''''[[Daptomycin]] 4mg/kg IV q24h'''''<BR> OR <BR> ▸ '''''[[Doxycycline]] 100 mg PO q12h'''''<BR> OR <BR>▸ '''''[[Minocycline]] 100 mg PO q12h'''''<BR> OR <BR> ▸ '''''[[TMP-SMX]] 1 or 2 double-strength tablets ( | | style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | ▸ '''''[[Vancomycin]] 30 mg/kg IV q12h'''''<BR> OR <BR> ▸ '''''[[Linezolid]] 600 mg IV/PO q12h'''''<BR> OR <BR> ▸ '''''[[Clindamycin]] 300-450 mg PO q8h or 600 mg/kg IV q8h'''''<BR> OR <BR> ▸ '''''[[Daptomycin]] 4mg/kg IV q24h'''''<BR> OR <BR> ▸ '''''[[Doxycycline]] 100 mg PO q12h'''''<BR> OR <BR>▸ '''''[[Minocycline]] 100 mg PO q12h'''''<BR> OR <BR> ▸ '''''[[TMP-SMX]] 1 or 2 double-strength tablets (800/160 mg) PO q12h''''' | ||
|- | |- | ||
| style="padding: 0 5px; font-size: 90%; background: #F5F5F5;" align=left | '''''Children age >28 days''''' | | style="padding: 0 5px; font-size: 90%; background: #F5F5F5;" align=left | '''''Children age >28 days''''' | ||
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| style="padding: 0 5px; font-size: 90%; background: #F5F5F5;" align=left | '''''Children age >28 days''''' | | style="padding: 0 5px; font-size: 90%; background: #F5F5F5;" align=left | '''''Children age >28 days''''' | ||
|- | |- | ||
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | ▸ '''''[[Amoxicillin-clavulanate]] 20 mg/kg PO divided q12h'''''<BR>OR<BR> ▸ '''''[[Ampicillin sulbactam]] 50 mg/kg IV q6h''''' | | style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | ▸ '''''[[Amoxicillin-clavulanate]] 20 mg/kg PO divided q12h'''''<BR>OR<BR> ▸ '''''[[Ampicillin sulbactam]] 50 mg/kg IV q6h'''''<BR> OR <BR> '''''[[Ertapenem]] 1 g IM/IV q24h''''' | ||
|- | |- | ||
| style="padding: 0 5px; font-size: 90%; background: #F5F5F5;" align=center | '''''Alternative Regimen''''' | | style="padding: 0 5px; font-size: 90%; background: #F5F5F5;" align=center | '''''Alternative Regimen''''' | ||
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| style="padding: 0 5px; font-size: 90%; background: #F5F5F5;" align=left | '''''Adults''''' | | style="padding: 0 5px; font-size: 90%; background: #F5F5F5;" align=left | '''''Adults''''' | ||
|- | |- | ||
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | | | style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | ▸ '''''[[Cefoxitin]] 1 g IV q4h or 2 g IV q8h'''''<BR> OR <BR> ▸ | ||
'''''[[Meropenem]] 1 g IV q8h'''''<BR> OR <BR> ▸ '''''[[Imipenem cilastatin]] 500 mg IV q6h''''' | |||
|- | |||
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | OR | |||
|- | |||
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | ▸ '''''[[Doxycycline]] 100 mg PO/IV q12h''''' <BR> PLUS <BR> ▸ '''''[[Clindamycin]] 450 mg PO or 600 mg IV q8h''''' | |||
|- | |||
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | OR | |||
|- | |||
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | ▸ '''''[[TMP-SMX]] 1 double strength tablet (800/160 mg) PO q12h or 8-20 mg/kg IV divided q6-12h''''' <BR> PLUS <BR> ▸ '''''[[Clindamycin]] 450 mg PO or 600 mg IV q8h''''' | |||
|- | |||
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | OR | |||
|- | |||
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left |▸ '''''[[Moxifloxacin]] 400 mg PO/IV q24h''''' <BR> PLUS <BR> ▸ '''''[[Clindamycin]] 450 mg PO or 600 mg IV q8h''''' | |||
|- | |- | ||
| style="padding: 0 5px; font-size: 90%; background: #F5F5F5;" align=left | '''''Children age >28 days''''' | | style="padding: 0 5px; font-size: 90%; background: #F5F5F5;" align=left | '''''Children age >28 days''''' | ||
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|} | |} | ||
===Chronic Lymphangitis=== | ===Chronic Granulomatous Lymphangitis=== | ||
====Pathogen Based Therapy==== | ====Pathogen Based Therapy==== | ||
<SMALL><font color="#FF4C4C">'''▸ Click on the following categories to expand treatment regimens.'''</font | <SMALL><font color="#FF4C4C">'''▸ Click on the following categories to expand treatment regimens.'''</font></SMALL> | ||
{| | {| | ||
| valign=top | | | valign=top | | ||
<div style="border-radius: 5px 5px 0 0; border: solid 1px #20538D; border-bottom: 0px; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 30px; line-height: 30px; width: | <div style="border-radius: 5px 5px 0 0; border: solid 1px #20538D; border-bottom: 0px; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 30px; line-height: 30px; width: 320px; background: #A1BCDD; text-align: center;"> | ||
<font color="#FFF"> | <font color="#FFF"> | ||
'''Bacteria''' | '''Bacteria''' | ||
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</div> | </div> | ||
<div class="mw-customtoggle-table09" style="cursor: pointer; border-radius: 0 0 0 0; border: solid 1px #20538D; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 30px; line-height: 30px; width: | <div class="mw-customtoggle-table09" style="cursor: pointer; border-radius: 0 0 0 0; border: solid 1px #20538D; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 30px; line-height: 30px; width: 320px; background: #4479BA;"> | ||
<font color="#FFF"> | <font color="#FFF"> | ||
▸ '''Mycobacterium Marinum''' | ▸ '''Mycobacterium Marinum''' | ||
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</div> | </div> | ||
<div style="border-radius: | <div style="border-radius: 0 0 0 0; border: solid 1px #20538D; border-bottom: 0px; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 30px; line-height: 30px; width: 320px; background: #A1BCDD; text-align: center;"> | ||
<font color="#FFF"> | <font color="#FFF"> | ||
'''Fungi''' | '''Fungi''' | ||
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</div> | </div> | ||
<div class="mw-customtoggle-table10" style="cursor: pointer; border-radius: 0 0 0 0; border: solid 1px #20538D; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 30px; line-height: 30px; width: | <div class="mw-customtoggle-table10" style="cursor: pointer; border-radius: 0 0 0 0; border: solid 1px #20538D; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 30px; line-height: 30px; width: 320px; background: #4479BA;"> | ||
<font color="#FFF"> | <font color="#FFF"> | ||
▸ '''Sporothrix Schenckii''' | ▸ '''Sporothrix Schenckii''' | ||
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</div> | </div> | ||
<div style="border-radius: | <div style="border-radius: 0 0 0 0; border: solid 1px #20538D; border-bottom: 0px; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 30px; line-height: 30px; width: 320px; background: #A1BCDD; text-align: center;"> | ||
<font color="#FFF"> | <font color="#FFF"> | ||
'''Parasites''' | '''Parasites''' | ||
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</div> | </div> | ||
<div class="mw-customtoggle-table11" style="cursor: pointer; border-radius: 0 0 0 0; border: solid 1px #20538D; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 30px; line-height: 30px; width: | <div class="mw-customtoggle-table11" style="cursor: pointer; border-radius: 0 0 0 0; border: solid 1px #20538D; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 30px; line-height: 30px; width: 320px; background: #4479BA;"> | ||
<font color="#FFF"> | <font color="#FFF"> | ||
▸ '''Brugia Malayi''' | ▸ '''Brugia Malayi''' | ||
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</div> | </div> | ||
<div class="mw-customtoggle-table12" style="cursor: pointer; border-radius: 0 0 5px 5px; border: solid 1px #20538D; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 30px; line-height: 30px; width: | <div class="mw-customtoggle-table12" style="cursor: pointer; border-radius: 0 0 5px 5px; border: solid 1px #20538D; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 30px; line-height: 30px; width: 320px; background: #4479BA;"> | ||
<font color="#FFF"> | <font color="#FFF"> | ||
▸ '''Wuchereria Bancrofti''' | ▸ '''Wuchereria Bancrofti''' | ||
Line 356: | Line 396: | ||
| style="padding: 0 5px; font-size: 90%; background: #F5F5F5;" align=center | '''''Preferred Regimen''''' | | style="padding: 0 5px; font-size: 90%; background: #F5F5F5;" align=center | '''''Preferred Regimen''''' | ||
|- | |- | ||
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | ▸ '''''[[Clarithromycin]] 500 mg PO q12h PLUS [[Ethambutol]] 15 mg/kg PO q24h''''' | | style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | ▸ '''''[[Clarithromycin]] 500 mg PO q12h''''' | ||
|- | |||
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | PLUS | |||
|- | |||
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | ▸ '''''[[Ethambutol]] 15 mg/kg PO q24h''''' | |||
|- | |||
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | OR ▸ '''''[[Rifampin]] 600 mg PO q24h''''' | |||
|- | |||
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | PLUS | |||
|- | |||
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | ▸ '''''[[Ethambutol]] 15 mg/kg PO q24h''''' | |||
|- | |||
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | <small>''Adapted from | |||
Eur J Clin Microbiol Infect Dis. 2006 Oct;25(10):609-13.''<ref name="pmid17047903">{{cite journal| author=Petrini B| title=Mycobacterium marinum: ubiquitous agent of waterborne granulomatous skin infections. | journal=Eur J Clin Microbiol Infect Dis | year= 2006 | volume= 25 | issue= 10 | pages= 609-13 | pmid=17047903 | doi=10.1007/s10096-006-0201-4 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17047903 }} </ref> ''Am J Respir Crit Care Med. 2007 Feb 15;175(4):367-416.''<ref name="pmid17277290">{{cite journal| author=Griffith DE, Aksamit T, Brown-Elliott BA, Catanzaro A, Daley C, Gordin F et al.| title=An official ATS/IDSA statement: diagnosis, treatment, and prevention of nontuberculous mycobacterial diseases. | journal=Am J Respir Crit Care Med | year= 2007 | volume= 175 | issue= 4 | pages= 367-416 | pmid=17277290 | doi=10.1164/rccm.200604-571ST | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17277290 }} </ref></small> | |||
|- | |- | ||
|} | |} | ||
Line 368: | Line 421: | ||
| style="padding: 0 5px; font-size: 90%; background: #F5F5F5;" align=center | '''''Preferred Regimen''''' | | style="padding: 0 5px; font-size: 90%; background: #F5F5F5;" align=center | '''''Preferred Regimen''''' | ||
|- | |- | ||
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | ▸ '''''[[Itraconazole]] 200 mg PO | | style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | ▸ '''''[[Itraconazole]] 200 mg PO q24h''''' | ||
|- | |||
| style="padding: 0 5px; font-size: 90%; background: #F5F5F5;" align=center | '''''Alternative Regimen†''''' | |||
|- | |- | ||
| style=" | | style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | ▸ '''''[[Itraconazole]] 200 mg PO q12h'''''<BR> OR <BR> ▸ '''''[[Terbinafine]] 500 mg PO q12h'''''<BR> OR <BR> ▸ '''''[[Potassium iodide|Saturated solution of potassium iodide]] 5-50 drops q8h'''''<BR> OR <BR> ▸ '''''[[Fluconazole]]¶ 400-800 mg/day PO''''' | ||
|- | |||
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | <SMALL><sup>†</sup> If there is no improvement after preferred treatment <br> <sup>¶</sup> Only administer if patient can't tolerate other antifungal agents</SMALL> | |||
|- | |- | ||
| style="font-size: 90% | | style="padding: 0 5px; font-size: 90%; background: #F5F5F5;" align=center | <small> ''Adapted from Clin Infect Dis. 2007 Nov 15;45(10):1255-65. Epub 2007 Oct 8'' <ref name="pmid17968818">{{cite journal| author=Kauffman CA, Bustamante B, Chapman SW, Pappas PG, Infectious Diseases Society of America| title=Clinical practice guidelines for the management of sporotrichosis: 2007 update by the Infectious Diseases Society of America. | journal=Clin Infect Dis | year= 2007 | volume= 45 | issue= 10 | pages= 1255-65 | pmid=17968818 | doi=10.1086/522765 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17968818 }} </ref></small> | ||
|- | |- | ||
|} | |} | ||
Line 386: | Line 443: | ||
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | ▸ '''''[[Diethylcarbamazine]] 6 mg/kg/day PO''''' | | style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | ▸ '''''[[Diethylcarbamazine]] 6 mg/kg/day PO''''' | ||
|- | |||
| style="padding: 0 5px; font-size: 90%; background: #F5F5F5;" align=center | <small> ''Adapted from Parasites - Lymphatic Filariasis CDC page.'' <ref name="cdc.gov">{{Cite web | last = | first = | title = Parasites - Lymphatic Filariasis | url = http://www.cdc.gov/parasites/lymphaticfilariasis/treatment.html | publisher = | date = | accessdate = }}</ref></small> | |||
|- | |- | ||
|} | |} | ||
Line 399: | Line 458: | ||
|- | |- | ||
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | ▸ '''''[[Diethylcarbamazine]] 6 mg/kg/day PO''''' | | style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | ▸ '''''[[Diethylcarbamazine]] 6 mg/kg/day PO''''' | ||
|- | |||
| style="padding: 0 5px; font-size: 90%; background: #F5F5F5;" align=center | <small> ''Adapted from Parasites - Lymphatic Filariasis CDC page.'' <ref name="cdc.gov">{{Cite web | last = | first = | title = Parasites - Lymphatic Filariasis | url = http://www.cdc.gov/parasites/lymphaticfilariasis/treatment.html | publisher = | date = | accessdate = }}</ref></small> | |||
|- | |- | ||
|} | |} | ||
|} | |} | ||
|} | |} | ||
===Lymphantic Filarisis=== | |||
*Lymphatic [[filariasis]] can be treated with a one-day or a 12-day [[diethylcarbamazine]] regimen. The one-day regimen is as effective as the 12-day regimen.<ref name="cdc.gov">{{Cite web | last = | first = | title = Parasites - Lymphatic Filariasis | url = http://www.cdc.gov/parasites/lymphaticfilariasis/treatment.html | publisher = | date = | accessdate = }}</ref> | |||
== Lymphangitis due to non-infectious etiology == | |||
Medical therapy for lymphangitis due to non-infectious etiology include: | |||
== | ===Lymphangitic carcinomatosis=== | ||
* | *Currently, no effective strategies available in treating lymphangitis carcinomatosa <ref name="pmid22693377">{{cite journal| author=Raja A, Seshadri RA, Sundersingh S| title=Lymphangitis carcinomatosa: report of a case and review of literature. | journal=Indian J Surg Oncol | year= 2010 | volume= 1 | issue= 3 | pages= 274-6 | pmid=22693377 | doi=10.1007/s13193-011-0047-9 | pmc=3244248 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22693377 }} </ref> | ||
* | *Steroid administration could produce symptomatic improvement mainly by alleviating breathlessness.<ref name="pmid8930034">{{cite journal| author=Bruce DM, Heys SD, Eremin O| title=Lymphangitis carcinomatosa: a literature review. | journal=J R Coll Surg Edinb | year= 1996 | volume= 41 | issue= 1 | pages= 7-13 | pmid=8930034 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8930034 }} </ref> | ||
*Poor prognosis<ref name="pmid8930034">{{cite journal| author=Bruce DM, Heys SD, Eremin O| title=Lymphangitis carcinomatosa: a literature review. | journal=J R Coll Surg Edinb | year= 1996 | volume= 41 | issue= 1 | pages= 7-13 | pmid=8930034 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8930034 }} </ref> | |||
=== Sclerosis Lymphangitis === | |||
* Sclerosis lymphangitis is a self-limiting disease, resolving spontaneously within several weeks, if restrained from vigorous sexual activity.<ref name="pmid26228831" /><ref name="pmid25592644" /> | |||
* No treatment is required, NSAID's have been recommended but without proven benefit. | |||
==References== | ==References== | ||
{{reflist|2}} | {{reflist|2}} | ||
{{WH}} | {{WH}} | ||
{{WS}} | {{WS}} | ||
[[Category:Inflammations]] | [[Category:Inflammations]] | ||
[[Category:Disease]] | |||
[[Category:Emergency mdicine]] | |||
[[Category:Up-To-Date]] | |||
[[Category:Infectious disease]] | [[Category:Infectious disease]] | ||
[[Category: | [[Category:Vascular medicine]] | ||
Latest revision as of 22:36, 29 July 2020
Lymphangitis Microchapters |
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American Roentgen Ray Society Images of Lymphangitis medical therapy |
Risk calculators and risk factors for Lymphangitis medical therapy |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Vendhan Ramanujam M.B.B.S [2],Faizan Sheraz, M.D. [3]Vishal Devarkonda, M.B.B.S[4]
Overview
Lymphangitis being a manifestation of wide concurrently occurring spectrum of manifestations or pathologies.The medical therapy varies from etiology to etiology. The mainstay of therapy for lymphangitis of infectious origin is antimicrobial therapy. Supportive therapy includes analgesics, anti-inflammatory agents, and warm compresses. Specific anitmicrobial treatment for individual infections are discussed in detail separately.
Medical Therapy
The mainstay of therapy for lymphangitis of infectious origin is antimicrobial therapy. Supportive therapy includes analgesics, anti-inflammatory agents, and warm compresses.
Lymphangitis of infectious etiology
Common preferred and accepted therapy for lymphangitis of infectious origin include: Dicloxacillin or Cephalexin
- Preferred regimen: Dicloxacillin
- Preferred regimen: Cephalexin 500 mg PO qid for 1 week
- 2. Patient with lymphangitis and if Community-Associated Methicillin-Resistant Staphylococcus Aureus (CA-MRSA) suspected:
- Trimethoprim-sulfamethoxazole PO bid AND vancomycin 1 g IV every 12 hr
- 3.Patient with lymphangitis allergic to penicillin:
- Clindamycin 300 mg PO qid for 7 days OR Erythromycin 500 mg PO qid for 7 days OR Levofloxacin 500 mg PO daily OR Moxifloxacin 400 mg PO daily for 7 days.
Empiric Therapy Adapted from Mandell, Douglas, and Bennett's Principles and Practice of Infectious Diseases.[2]Adapted from Clin Infect Dis. 2005 Nov 15;41(10):1373-406.[3] J Emerg Med. 2013 Jun;44(6):e397-412.[4]Clin Infect Dis. 2011 Feb 1;52(3):e18-55.[5]
▸ Click on the following categories to expand treatment regimens.
Mild - Moderate Acute Lymphangitis ▸ Adults ▸ Children age >28 days Severe Acute Lymphangitis ▸ Adults ▸ Children age >28 days |
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Pathogen Based Therapy Adapted from Clin Infect Dis. 2005 Nov 15;41(10):1373-406.[3] J Emerg Med. 2013 Jun;44(6):e397-412.[4]Clin Infect Dis. 2011 Feb 1;52(3):e18-55.[5]
▸ Click on the following categories to expand treatment regimens.
Bacteria ▸ Streptococcus Pyogenes ▸ Methicillin Sensitive Staphylococcus Aureus ▸ Methicillin Resistant Staphylococcus Aureus ▸ Pasteurella Multocida |
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Chronic Granulomatous Lymphangitis
Pathogen Based Therapy
▸ Click on the following categories to expand treatment regimens.
Bacteria ▸ Mycobacterium Marinum Fungi ▸ Sporothrix Schenckii Parasites ▸ Brugia Malayi ▸ Wuchereria Bancrofti |
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Lymphantic Filarisis
- Lymphatic filariasis can be treated with a one-day or a 12-day diethylcarbamazine regimen. The one-day regimen is as effective as the 12-day regimen.[9]
Lymphangitis due to non-infectious etiology
Medical therapy for lymphangitis due to non-infectious etiology include:
Lymphangitic carcinomatosis
- Currently, no effective strategies available in treating lymphangitis carcinomatosa [10]
- Steroid administration could produce symptomatic improvement mainly by alleviating breathlessness.[11]
- Poor prognosis[11]
Sclerosis Lymphangitis
- Sclerosis lymphangitis is a self-limiting disease, resolving spontaneously within several weeks, if restrained from vigorous sexual activity.[12][13]
- No treatment is required, NSAID's have been recommended but without proven benefit.
References
- ↑ lymphanitis Mandell, GERALD L. "Mandell, Douglas, and Bennett's." Principles and practice of infectious diseases 7 (1995) Accessed on October 12,2016
- ↑ Mandell, Gerald L.; Bennett, John E. (John Eugene); Dolin, Raphael. (2010). Mandell, Douglas, and Bennett's principles and practice of infectious disease. Philadelphia, PA: Churchill Livingstone/Elsevier.
- ↑ 3.0 3.1 Stevens DL, Bisno AL, Chambers HF, Everett ED, Dellinger P, Goldstein EJ; et al. (2005). "Practice guidelines for the diagnosis and management of skin and soft-tissue infections". Clin Infect Dis. 41 (10): 1373–406. doi:10.1086/497143. PMID 16231249.
- ↑ 4.0 4.1 Moran GJ, Abrahamian FM, Lovecchio F, Talan DA (2013). "Acute bacterial skin infections: developments since the 2005 Infectious Diseases Society of America (IDSA) guidelines". J Emerg Med. 44 (6): e397–412. doi:10.1016/j.jemermed.2012.11.050. PMID 23466022.
- ↑ 5.0 5.1 Liu C, Bayer A, Cosgrove SE, Daum RS, Fridkin SK, Gorwitz RJ; et al. (2011). "Clinical practice guidelines by the infectious diseases society of america for the treatment of methicillin-resistant Staphylococcus aureus infections in adults and children". Clin Infect Dis. 52 (3): e18–55. doi:10.1093/cid/ciq146. PMID 21208910.
- ↑ Petrini B (2006). "Mycobacterium marinum: ubiquitous agent of waterborne granulomatous skin infections". Eur J Clin Microbiol Infect Dis. 25 (10): 609–13. doi:10.1007/s10096-006-0201-4. PMID 17047903.
- ↑ Griffith DE, Aksamit T, Brown-Elliott BA, Catanzaro A, Daley C, Gordin F; et al. (2007). "An official ATS/IDSA statement: diagnosis, treatment, and prevention of nontuberculous mycobacterial diseases". Am J Respir Crit Care Med. 175 (4): 367–416. doi:10.1164/rccm.200604-571ST. PMID 17277290.
- ↑ Kauffman CA, Bustamante B, Chapman SW, Pappas PG, Infectious Diseases Society of America (2007). "Clinical practice guidelines for the management of sporotrichosis: 2007 update by the Infectious Diseases Society of America". Clin Infect Dis. 45 (10): 1255–65. doi:10.1086/522765. PMID 17968818.
- ↑ 9.0 9.1 9.2 "Parasites - Lymphatic Filariasis".
- ↑ Raja A, Seshadri RA, Sundersingh S (2010). "Lymphangitis carcinomatosa: report of a case and review of literature". Indian J Surg Oncol. 1 (3): 274–6. doi:10.1007/s13193-011-0047-9. PMC 3244248. PMID 22693377.
- ↑ 11.0 11.1 Bruce DM, Heys SD, Eremin O (1996). "Lymphangitis carcinomatosa: a literature review". J R Coll Surg Edinb. 41 (1): 7–13. PMID 8930034.
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