Suppurative thrombophlebitis medical therapy: Difference between revisions

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Revision as of 18:49, 19 August 2015

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Overview

The mainstay of therapy for suppurative thrombophlebitis is antimicrobial therapy. Empiric therapy includes anti-staphylococcal antibiotics plus antibiotics with coverage against enterobacteriaceae. The benefit of pharmacologic anticoagulation is uncertain in suppurative thrombophlebitis and is not routinely recommended.

Medical Therapy

Antimicrobial Regimens

Treatment of suppurative thrombophlebitis

1. Bacterial pathogens

1.1 Gram-positive bacilli

1.1.1 Staphylococcus aureus

1.1.1.1 Methicillin-sensitive

Preferred regimen:

Alternative regimen:

1.1.1.2 Methicillin-resistant

Preferred regimen:

Alternative regimen:

1.1.2 Coagulase-negative staphylococci

1.1.2.1 Methicillin-sensitive

Preferred regimen:

Alternative regimen:

1.1.2.2 Methicillin-resistant

Preferred regimen:

Alternative regimen:

1.1.3 Enterococcus faecalis & Enterococcus faecium

1.1.3.1 Ampicillin-sensitive

Preferred regimen:

Alternative regimen:

1.1.3.2 Ampicillin-resistant & Vancomycin-sensitive

Preferred regimen:

Alternative regimen:

1.1.3.3 Ampicillin-resistant & Vancomycin-resistant

Preferred regimen:

Alternative regimen:

1.2 Gram-negative bacilli

1.2.1 Escherichia coli & Klebsiella spp.

1.2.1.1 ESBL negative

Preferred regimen:

Alternative regimen:

1.2.1.2 ESBL negative

Preferred regimen:

Alternative regimen:

1.2.2 Enterobacter spp. & Serratia marcescens

Preferred regimen:

Alternative regimen:

1.2.3 Acinetobacter spp.

Preferred regimen:

Alternative regimen:

1.2.4 Stenotrophomonas maltophilia

Preferred regimen:

Alternative regimen:

1.2.5 Pseudomonas aeruginosa

Preferred regimen:

Alternative regimen:

1.2.6 Burkholderia cepacia

Preferred regimen:

Alternative regimen:

2. Fungal pathogens

2.1 Candida spp.

Preferred regimen:

Alternative regimen:

3. Uncommon pathogens

3.1 Corynebacterium jeikeium

Preferred regimen:

Alternative regimen:

3.2 Chryseobacterium (Flavobacterium) spp.

Preferred regimen:

Alternative regimen:

3.3 Ochrobacterium anthropi

Preferred regimen:

Alternative regimen:

3.4 Malassezia furfur

Preferred regimen:

Alternative regimen:

3.5 Mycobacterium species

Preferred regimen:

Alternative regimen:

References

Template:WikiDoc Sources

@@ Line 2: / Line 2: @@
 {{Suppurative thrombophlebitis}}
 {{CMG}}
+==Overview==
+The mainstay of therapy for suppurative thrombophlebitis is antimicrobial therapy.  Empiric therapy includes anti-staphylococcal antibiotics plus antibiotics with coverage against ''[[enterobacteriaceae]]''. The benefit of pharmacologic [[anticoagulation]] is uncertain in suppurative thrombophlebitis and is not routinely recommended.
 ==Medical Therapy==
-===Overview===
+===Antimicrobial Regimens===
-The mainstay of therapy for suppurative thrombophlebitis is antimicrobial therapy.  Empiric therapy includes anti-staphylococcal antibiotics plus antibiotics with coverage against ''[[enterobacteriaceae]]''. The benefit of pharmacologic [[anticoagulation]] is uncertain in suppurative thrombophlebitis and is not routinely recommended.
+* Treatment of suppurative thrombophlebitis
+:* '''1. Bacterial pathogens'''
+::* '''1.1 Gram-positive bacilli'''
+:::* '''1.1.1 Staphylococcus aureus'''
+::::* '''1.1.1.1 Methicillin-sensitive'''
+:::::* Preferred regimen:
+:::::* Alternative regimen:
+::::* '''1.1.1.2 Methicillin-resistant'''
+:::::* Preferred regimen:
+:::::* Alternative regimen:
+:::* '''1.1.2 Coagulase-negative staphylococci'''
+::::* '''1.1.2.1 Methicillin-sensitive'''
+:::::* Preferred regimen:
+:::::* Alternative regimen:
+::::* '''1.1.2.2 Methicillin-resistant'''
+:::::* Preferred regimen:
+:::::* Alternative regimen:
+:::* '''1.1.3 Enterococcus faecalis & Enterococcus faecium'''
+::::* '''1.1.3.1 Ampicillin-sensitive'''
+:::::* Preferred regimen:
+:::::* Alternative regimen:
+::::* '''1.1.3.2 Ampicillin-resistant & Vancomycin-sensitive'''
+:::::* Preferred regimen:
+:::::* Alternative regimen:
+::::* '''1.1.3.3 Ampicillin-resistant & Vancomycin-resistant'''
+:::::* Preferred regimen:
+:::::* Alternative regimen:
+::* '''1.2 Gram-negative bacilli'''
+:::* '''1.2.1 Escherichia coli & Klebsiella spp.'''
+::::* '''1.2.1.1 ESBL negative'''
+:::::* Preferred regimen:
+:::::* Alternative regimen:
+::::* '''1.2.1.2 ESBL negative'''
+:::::* Preferred regimen:
+:::::* Alternative regimen:
+:::* '''1.2.2 Enterobacter spp. & Serratia marcescens'''
+::::* Preferred regimen:
+::::* Alternative regimen:
+:::* '''1.2.3 Acinetobacter spp.'''
+::::* Preferred regimen:
+::::* Alternative regimen:
+:::* '''1.2.4 Stenotrophomonas maltophilia'''
+::::* Preferred regimen:
+::::* Alternative regimen:
+:::* '''1.2.5 Pseudomonas aeruginosa'''
+::::* Preferred regimen:
+::::* Alternative regimen:
+:::* '''1.2.6 Burkholderia cepacia'''
+::::* Preferred regimen:
+::::* Alternative regimen:
+:* '''2. Fungal pathogens'''
+::* '''2.1 Candida spp.'''
+:::* Preferred regimen:
+:::* Alternative regimen:
+:* '''3. Uncommon pathogens'''
+::* '''3.1 Corynebacterium jeikeium'''
+:::* Preferred regimen:
+:::* Alternative regimen:
+::* '''3.2 Chryseobacterium (Flavobacterium) spp.'''
+:::* Preferred regimen:
+:::* Alternative regimen:
+::* '''3.3 Ochrobacterium anthropi'''
+:::* Preferred regimen:
+:::* Alternative regimen:
-===Peripheral Vein Suppurative Thrombophlebitis===
+::* '''3.4 Malassezia furfur'''
-Till the blood culture results detect the targeted pathogen, empiric antibiotic therapy is given aiming to include an agent with activity against [[staphylococci]] plus an agent with activity against [[enterobacteriaceae]].
-{|
+:::* Preferred regimen:
-| valign=top |
-{| style="margin: 0 0 0em 0em; border: 1px solid #696969; float: left; width:48em" cellpadding="0" cellspacing="0";
-! style="padding: 0 5px; font-size: 100%; background: #F8F8FF" align=center | ''{{fontcolor|#6C7B8B|Peripheral Vein Suppurative Thrombophlebitis}}''
-|-
-| style="font-size: 95%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Vancomycin]] 15 to 20 mg/kg/dose every 8 to 12 hours, not to exceed 2 g per dose x minimum of 2Wks '''''
-|-
-| style="font-size: 95%; padding: 0 5px; background: #DCDCDC" align=left | PLUS
-|-
-| style="font-size: 95%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Ceftriaxone]] 1 g IV daily x minimum of 2Wks'''''
-|-
-|}
-|}
-===Jugular Vein Suppurative Thrombophlebitis===
+:::* Alternative regimen:
-A beta-lactamase resistant beta-lactam antibiotic should be used in cases of jugular vein suppurative thrombophlebitis.
-{|
+::* '''3.5 Mycobacterium species'''
-| valign=top |
-{| style="margin: 0 0 0em 0em; border: 1px solid #696969; float: left; width:48em" cellpadding="0" cellspacing="0";
-! style="padding: 0 5px; font-size: 100%; background: #F8F8FF" align=center | ''{{fontcolor|#6C7B8B|Jugular Vein Suppurative Thrombophlebitis}}''
-|-
-| style="font-size: 95%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[ampicillin sulbactam|Ampicillin-sulbactam]] 3 g every six hours x 4 Wks '''''<BR>''OR''<BR>▸ '''''[[Piperacillin|Piperacillin-tazobactam]] 4.5 g every six hours x 4 Wks'''''<BR>''OR''<BR>▸ '''''[[ticarcillin|Ticarcillin-clavulanate]] 3.1 g every six hours x 4 Wks'''''
-|-
-| style="font-size: 95%; padding: 0 5px; background: #DCDCDC" align=left | PLUS
-|-
-| style="font-size: 95%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Vancomycin]] 15 to 20 mg/kg/dose every 8 to 12 hours, not to exceed 2 g per dose x 4 Wks '''''
-|-
-|}
-|}
-===Vena Cava Suppurative Thrombophlebitis===
+:::* Preferred regimen:
-{|
+:::* Alternative regimen:
-| valign=top |
-{| style="margin: 0 0 0em 0em; border: 1px solid #696969; float: left; width:48em" cellpadding="0" cellspacing="0";
-! style="padding: 0 5px; font-size: 100%; background: #F8F8FF" align=center | ''{{fontcolor|#6C7B8B|Vena Cava Suppurative Thrombophlebitis}}''
-|-
-| style="font-size: 95%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Vancomycin]] 15 to 20 mg/kg/dose every 8 to 12 hours, not to exceed 2 g per dose x 4 to 6 Wks '''''
-|-
-| style="font-size: 95%; padding: 0 5px; background: #DCDCDC" align=left | PLUS
-|-
-| style="font-size: 95%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Ceftriaxone]] 1 g IV daily x 4 to 6 Wks'''''
-|-
-|}
-|}
 ==References==