Suppurative thrombophlebitis medical therapy

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

Medical Therapy

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.

Peripheral Vein Suppurative Thrombophlebitis

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.

Peripheral Vein Suppurative Thrombophlebitis ▸ Vancomycin 15 to 20 mg/kg/dose every 8 to 12 hours, not to exceed 2 g per dose x minimum of 2Wks PLUS ▸ Ceftriaxone 1 g IV daily x minimum of 2Wks

Jugular Vein Suppurative Thrombophlebitis

A beta-lactamase resistant beta-lactam antibiotic should be used in cases of jugular vein suppurative thrombophlebitis.

Jugular Vein Suppurative Thrombophlebitis ▸ Ampicillin-sulbactam 3 g every six hours x 4 Wks OR ▸ Piperacillin-tazobactam 4.5 g every six hours x 4 Wks OR ▸ Ticarcillin-clavulanate 3.1 g every six hours x 4 Wks PLUS ▸ 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

Vena Cava Suppurative Thrombophlebitis ▸ Vancomycin 15 to 20 mg/kg/dose every 8 to 12 hours, not to exceed 2 g per dose x 4 to 6 Wks PLUS ▸ Ceftriaxone 1 g IV daily x 4 to 6 Wks

Septic pelvic vein thrombophlebitis

• Based on the CT and MRI findings septic pelvic vein thrombophlebitis is classified into following categories for management..

• 1. Right ovarian vein thrombosis

• Preferred regimen (1): Ertapenem 1 g PO qd for 7 days AND Enoxaparin (1 mg/Kg) initially AND 3–6 months of Warfarin (INR 2.5)
• Preferred regimen (2): Gentamicin 4 mg/kg AND Ampicillin 2 g AND Clindamycin 1200 mg for 7 days AND Enoxaparin (1 mg/Kg) initially AND 3–6 months Warfarin (INR 2.5).
• Note: Repeat CT scan after 3 months. If negative, stop anticoagulation. If still positive for thrombi, anticoagulate for 3 additional months.

• 2. Pelvic branch vein thrombosis

• Preferred regimen (1): Ertapenem 1 g PO qd for 7 days AND Enoxaparin (1 mg/Kg) PO for 2 weeks
• Preferred regimen (2): Gentamicin (4 mg/kg) PO AND Ampicillin 2 g PO AND Clindamycin 1200 mg PO for 7 days AND Enoxaparin (1 mg/Kg) for 2 weeks.

• 3. Negative for pelvic thrombi

• Preferred regimen (1): Ertapenem 1 g PO qd for 7 days AND Enoxaparin (1 mg/Kg) for 1 week
• Preferred regimen (2): Gentamicin (4 mg/kg) PO qd AND Ampicillin 2 g PO qd AND Clindamycin 1200 mg PO qd for 7 days AND Enoxaparin (1 mg/Kg) PO qd for 1 weeks

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