Suppurative thrombophlebitis medical therapy

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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: Nafcillin 2 g IV q4h OR Oxacillin 2 g IV q4h
• Alternative regimen: Cefazolin 2 g IV q8h OR Vancomycin 15 mg/kg q12h (trough levels 15-20 mcg/ml)

• 1.1.1.2 Methicillin-resistant

• Preferred regimen: Vancomycin 15 mg/kg q12h (trough levels 15-20 mcg/ml)
• Alternative regimen (1): Daptomycin 6-8 mg/kg/day IV q24h OR Linezolid 600 mg IV q12h
• Alternative regimen (2): Trimethoprim-sulfamethoxazole 20 mg TMP/kg/day IV q6hr

• 1.1.2 Coagulase-negative staphylococci

• 1.1.2.1 Methicillin-sensitive

• Preferred regimen: Nafcillin 2 g IV q4h OR Oxacillin 2 g IV q4h
• Alternative regimen: Cefazolin 2 g IV q8h OR Vancomycin 15 mg/kg q12h (trough levels 15-20 mcg/ml)

• 1.1.2.2 Methicillin-resistant

• Preferred regimen: Vancomycin 15 mg/kg q12h (trough levels 15-20 mcg/ml)
• Alternative regimen: Daptomycin 6-8 mg/kg/day IV q24h OR Linezolid 600 mg IV q12h OR Quinupristin/Dalfopristin 7.5 mg/kg IV q8h

• 1.1.3 Enterococcus faecalis & Enterococcus faecium

• 1.1.3.1 Ampicillin-sensitive

• Preferred regimen: Ampicillin 2 g IV q4-6h ± Gentamicin 1 mg/kg IV q8h
• 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

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