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Lymphangitis Medication

  • Author: Raymond D Pitetti, MD, MPH; Chief Editor: Russell W Steele, MD  more...
 
Updated: Aug 13, 2015
 

Medication Summary

Analgesics can help to control pain in patients with lymphangitis, and anti-inflammatory medications can help to reduce inflammation and swelling.

Antibiotics, including the following, can be used in the treatment of group A beta-hemolytic streptococci (GABHS) and S aureus infections:

  • Dicloxacillin
  • Cephalexin
  • Cefazolin
  • Cefuroxime
  • Ceftriaxone
  • Clindamycin
  • Nafcillin
  • Trimethoprim and sulfamethoxazole (TMP/SMZ)
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Antibiotics

Class Summary

Antibiotics provide empiric coverage for group A streptococcal species and S aureus. Acceptable outpatient regimens include penicillinase-resistant synthetic penicillin or a first-generation cephalosporin. Acceptable inpatient regimens include a second- or third-generation cephalosporin (eg, cefuroxime, ceftriaxone) or a penicillinase-resistant synthetic penicillin. In certain geographic areas of the country with high rates of methicillin-resistant S aureus (MRSA), alternative antimicrobial agents, such as clindamycin or TMP-SMZ, should be considered.

Dicloxacillin

 

Dicloxacillin binds to 1 or more penicillin-binding proteins, inhibiting synthesis of bacterial cell walls.

Cephalexin (Keflex)

 

Cephalexin, a first-generation cephalosporin, arrests bacterial growth by inhibiting bacterial cell-wall synthesis. It provides bactericidal activity against rapidly growing organisms.

Cefazolin

 

This agent is a first-generation, semi-synthetic cephalosporin that arrests bacterial cell-wall synthesis, inhibiting bacterial growth.

Cefuroxime (Zinacef, Ceftin)

 

Cefuroxime is a second-generation cephalosporin that arrests bacterial cell-wall synthesis, inhibiting bacterial growth.

Ceftriaxone (Rocephin)

 

Ceftriaxone, a third-generation cephalosporin, arrests bacterial growth by binding to 1 or more penicillin-binding proteins.

Clindamycin (Cleocin)

 

This agent is a semisynthetic antibiotic produced by 7(S)-chloro-substitution of the 7(R)-hydroxyl group of the parent compound, lincomycin. Clindamycin inhibits bacterial growth, possibly by blocking the dissociation of peptidyl transfer ribonucleic acid (tRNA) from ribosomes, causing RNA-dependent protein synthesis to arrest. Clindamycin widely distributes in the body without penetration of the central nervous system (CNS). The drug is protein bound and excreted by the liver and kidneys.

Clindamycin is used to treat serious skin and soft-tissue staphylococcal infections. It is also effective against aerobic and anaerobic streptococci but not against enterococci.

Nafcillin

 

Nafcillin binds to 1 or more penicillin-binding proteins, inhibiting synthesis of bacterial cell walls. Because of thrombophlebitis, administer this agent parenterally for only 1-2 days; change to oral antibiotic therapy as clinically indicated.

Trimethoprim and sulfamethoxazole (TMP/SMZ, Bactrim, Bactrim DS, Septra DS)

 

TMP/SMZ inhibits bacterial growth by inhibiting synthesis of dihydrofolic acid. Its antibacterial activity includes common urinary-tract pathogens, except Pseudomonas aeruginosa.

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Contributor Information and Disclosures
Author

Raymond D Pitetti, MD, MPH Associate Professor, Department of Pediatrics, Division of Pediatric Emergency Medicine, University of Pittsburgh School of Medicine; Associate Division Chief, Division of Pediatric Emergency Medicine, Associate Medical Director, Emergency Department, Medical Director, Sedation Services, Medical Director, Express Care, Medical Director, Patient Safety, Consulting Staff, Children's Hospital of Pittsburgh of UPMC and University of Pittsburgh Physicians

Raymond D Pitetti, MD, MPH is a member of the following medical societies: American Academy of Pediatrics, Pennsylvania Medical Society, Society for Pediatric Research, Allegheny County Medical Society

Disclosure: Nothing to disclose.

Chief Editor

Russell W Steele, MD Clinical Professor, Tulane University School of Medicine; Staff Physician, Ochsner Clinic Foundation

Russell W Steele, MD is a member of the following medical societies: American Academy of Pediatrics, American Association of Immunologists, American Pediatric Society, American Society for Microbiology, Infectious Diseases Society of America, Louisiana State Medical Society, Pediatric Infectious Diseases Society, Society for Pediatric Research, Southern Medical Association

Disclosure: Nothing to disclose.

Acknowledgements

Larry I Lutwick, MD Professor of Medicine, State University of New York Downstate Medical School; Director, Infectious Diseases, Veterans Affairs New York Harbor Health Care System, Brooklyn Campus

Larry I Lutwick, MD is a member of the following medical societies: American College of Physicians and Infectious Diseases Society of America

Disclosure: Nothing to disclose.

Gary J Noel, MD Professor, Department of Pediatrics, Weill Cornell Medical College; Attending Pediatrician, New York-Presbyterian Hospital

Gary J Noel, MD is a member of the following medical societies: Pediatric Infectious Diseases Society

Disclosure: Nothing to disclose.

Mary L Windle, PharmD Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

References
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  2. Akogun OB, Badaki JA. Management of adenolymphangitis and lymphoedema due to lymphatic filariasis in resource-limited North-eastern Nigeria. Acta Trop. 2011 Sep. 120 Suppl 1:S69-75. [Medline].

  3. Abraham S, Tschanz C, Krischer J, Saurat JH. Lymphangitis due to insect sting. Dermatology. 2007. 215(3):260-1. [Medline].

  4. Marque M, Girard C, Guillot B, Bessis D. Superficial lymphangitis after arthropod bite: a distinctive but underrecognized entity?. Dermatology. 2008. 217(3):262-7. [Medline].

  5. Tomas X, Pedrosa M, Soriano A, Zboromyrska Y, Tudo G, Garcia S, et al. Rare diagnosis of nodular lymphangitis caused by Mycobacterium marinum: MDCT imaging findings. Acta Radiol Short Rep. 2014 Feb. 3 (2):2047981614523172. [Medline].

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  7. [Guideline] Calfee DP, Salgado CD, Classen D, Arias KM, Podgorny K, Anderson DJ, et al. Strategies to prevent transmission of methicillin-resistant Staphylococcus aureus in acute care hospitals. Infect Control Hosp Epidemiol. 2008 Oct. 29 Suppl 1:S62-80. [Medline].

 
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