Lymphangitis medical therapy

Lymphangitis Microchapters
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Vendhan Ramanujam M.B.B.S [2]

Overview

Lymphangitis most often is an acute complication following an extension from the skin infection with the potential of a systemic spread. It has to be promptly treated with appropriate antibiotics along with analgesics, anti-inflammatory medications, warm and moist compresses. Certain conditions like nodular lymphagitis that is complicated by abscess and lymphedema with significant lymphatic obstruction may require surgical intervention.

Therapy Based on Clinical Form

Acute Lymphangitis

Empiric Therapy

▸ 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

Mild - Moderate Acute Lymphangitis - Adults Preferred Regimen ▸ Penicillin V 500 mg PO q6h Alternative Regimen For Life-Threatening Penicillin Allergies ▸ Clindamycin 300-450 mg PO q8h OR ▸ Vancomycin 15-20 mg/kg IV q8-12h For Suspected MSSA ▸ Dicloxacillin 500 mg PO q6h OR ▸ Cephalexin 500 mg PO q6h OR ▸ Clindamycin 300-450 mg PO q8h OR ▸ Erythromycin 500 mg PO q6h For Suspected MRSA ▸ Vancomycin 15-20 mg/kg IV q8-12h OR ▸ Linezolid 600 mg IV/PO q12h OR ▸ Daptomycin 4mg/kg IV q24h OR ▸ Clindamycin 600 mg IV/PO q8h OR ▸ Doxycycline 100 mg PO q12h OR ▸ Minocycline 100 mg PO q12h OR ▸ TMP-SMX 8-12 mg/kg PO q12h/IV q6h For Animal Bites ▸ Amoxicillin-clavulanate 875 mg PO q12h OR ▸ Doxycycline 100 mg PO q12h OR ▸ TMP-SMX PO 1 double-strength tablet (sulfamethoxazole 800 mg; trimethoprim 160 mg) q12h OR ▸ Moxifloxacin 400 PO mg q24h PLUS ▸ Clindamycin 450 mg PO q8h Mild - Moderate Acute Lymphangitis - Children Preferred Regimen ▸ Penicillin V 500 mg PO q6h Alternative Regimen For Life-Threatening Penicillin Allergies ▸ Clindamycin 10-13 mg/kg IV q6-8h OR ▸ Vancomycin 15 mg/kg IV q6h For Suspected MSSA ▸ Dicloxacillin 25 mg/kg PO divided q6h OR ▸ Cephalexin 25 mg/kg PO divided q6h OR ▸ Clindamycin 10-13 mg/kg IV q6-8h OR ▸ Erythromycin 10 mg/kg PO q6h For Suspected MRSA ▸ Vancomycin 15 mg/kg IV q6h OR ▸ Linezolid 10 mg/kg IV/PO q8h OR ▸ Daptomycin 5-9 mg/kg IV q24h OR ▸ Clindamycin 10-13 mg/kg IV/PO q6-8h OR ▸ Doxycycline ≤45 kg: 2 mg/kg PO q12h; >45 kg: 100 mg PO q12h OR ▸ Minocycline 2 mg/kg PO q12h OR ▸ TMP-SMX 8-12 mg/kg PO q12h/IV q6h For Animal Bites ▸ Amoxicillin-clavulanate 20 mg/kg PO divided q12h OR ▸ TMP-SMX 4-5 mg/kg (trimethoprim component) PO q12h OR ▸ Clindamycin 10 mg/kg PO q8h Severe Acute Lymphangitis - Adults Preferred Regimen ▸ Penicillin G 2-4 MU IV q4-6h Alternative Regimen For Life-Threatening Penicillin Allergies ▸ Clindamycin 300-450 mg PO q8h OR ▸ Vancomycin 15-20 mg/kg IV q8-12h For Suspected MSSA ▸ Dicloxacillin 500 mg PO q6h OR ▸ Cephalexin 500 mg PO q6h OR ▸ Clindamycin 300-450 mg PO q8h OR ▸ Erythromycin 500 mg PO q6h For Suspected MRSA ▸ Vancomycin 15-20 mg/kg IV q8-12h OR ▸ Linezolid 600 mg IV/PO q12h OR ▸ Daptomycin 4mg/kg IV q24h OR ▸ Clindamycin 600 mg IV/PO q8h OR ▸ Doxycycline 100 mg PO q12h OR ▸ Minocycline 100 mg PO q12h OR ▸ TMP-SMX 8-12 mg/kg PO q12h/IV q6h For Animal Bites ▸ Ampicillin sulbactam 3 g IV q6h OR ▸ Ertapenem 1 g IM/IV q24h OR ▸ Cefoxitin 1 g IV q4h or 2 g IV q8h OR ▸ Meropenem 1 g IV q8h OR ▸ Imipenem cilastatin 500 mg IV q6h OR ▸ Ciprofloxacin 400 mg IV q12h or Levofloxacin 500 IV mg q24h PLUS ▸ Metronidazole 500 mg IV q8h Severe Acute Lymphangitis - Children Preferred Regimen ▸ Penicillin G 2-4 MU IV q4-6h Alternative Regimen For Life-Threatening Penicillin Allergies ▸ Clindamycin 10-13 mg/kg IV q6-8h OR ▸ Vancomycin 15 mg/kg IV q6h For Suspected MSSA ▸ Dicloxacillin 25 mg/kg PO divided q6h OR ▸ Cephalexin 25 mg/kg PO divided q6h OR ▸ Clindamycin 10-13 mg/kg IV q6-8h OR ▸ Erythromycin 10 mg/kg PO q6h For Suspected MRSA ▸ Vancomycin 15 mg/kg IV q6h OR ▸ Linezolid 10 mg/kg IV/PO q8h OR ▸ Daptomycin 5-9 mg/kg IV q24h OR ▸ Clindamycin 10-13 mg/kg IV/PO q6-8h (max:40 mg/kg/day) OR ▸ Doxycycline ≤45 kg: 2 mg/kg PO q12h; >45 kg: 100 mg PO q12h OR ▸ Minocycline 2 mg/kg PO q12h OR ▸ TMP-SMX 8-12 mg/kg PO q12h/IV q6h For Animal Bites ▸ Ampicillin sulbactam 50 mg/kg IV q6h OR ▸ Ertapenem 15 mg/kg IM/IV q12h OR ▸ Cefoxitin 160 mg/kg IV divided q4-6h OR ▸ Meropenem 20 mg/kg IV q8h OR ▸ Imipenem cilastatin 25 mg/kg IV q6h

Pathogen Based Therapy

▸ Click on the following categories to expand treatment regimens.

Bacteria   ▸  Streptococcus Pyogenes   ▸  Methicillin Sensitive Staphylococcus Aureus   ▸  Methicillin Resistant Staphylococcus Aureus   ▸  Spirillum Minus Parasite   ▸  Brugia Malayi   ▸  Wuchereria Bancrofti Mild - Moderate Acute Lymphangitis - Adults Preferred Regimen ▸ Penicillin V 500 mg PO q6h Alternative Regimen For Life-Threatening Penicillin Allergies ▸ Clindamycin 300-450 mg PO q8h OR ▸ Vancomycin 15-20 mg/kg IV q8-12h For Suspected MSSA ▸ Dicloxacillin 500 mg PO q6h OR ▸ Cephalexin 500 mg PO q6h OR ▸ Clindamycin 300-450 mg PO q8h OR ▸ Erythromycin 500 mg PO q6h For Suspected MRSA ▸ Vancomycin 15-20 mg/kg IV q8-12h OR ▸ Linezolid 600 mg IV/PO q12h OR ▸ Daptomycin 4mg/kg IV q24h OR ▸ Clindamycin 600 mg IV/PO q8h OR ▸ Doxycycline 100 mg PO q12h OR ▸ Minocycline 100 mg PO q12h OR ▸ TMP-SMX 8-12 mg/kg PO q12h/IV q6h For Animal Bites ▸ Amoxicillin-clavulanate 875 mg PO q12h OR ▸ Doxycycline 100 mg PO q12h OR ▸ TMP-SMX PO 1 double-strength tablet (sulfamethoxazole 800 mg; trimethoprim 160 mg) q12h OR ▸ Moxifloxacin 400 PO mg q24h PLUS ▸ Clindamycin 450 mg PO q8h References