eMedicine Specialties > Pediatrics: General Medicine > Infectious Disease
Lymphangitis: Treatment & Medication
Updated: May 22, 2009
- Overview
- Differential Diagnoses & Workup
- Treatment & Medication
- Follow-up
- Multimedia
Treatment
Medical Care
- Treat children with lymphangitis with an appropriate antimicrobial agent.3
- Children in stable social situations who appear nontoxemic and who are older than 3 years, afebrile, and well hydrated may be treated initially with oral (PO) antibiotics on an outpatient basis. Ensure close follow up.
- Parenteral antibiotics may be required for a patient with signs of systemic illness (eg, fever, chills and myalgia, lymphangitis).
- Aggressively treat suspected cases of group A beta-hemolytic streptococcal (GABHS); these cases can progress rapidly and have been associated with serious complications.
- Analgesics can be used to control pain, and anti-inflammatory medications can help reduce inflammation and swelling. Hot, moist compresses also help reduce inflammation and pain.
Consultations
- An abscess may require surgical drainage.
Activity
- If possible, elevate and immobilize affected areas to reduce swelling, pain, and the spread of infection.
Medication
Treat children with lymphangitis with an appropriate antimicrobial agent. Analgesics can help control pain, and anti-inflammatory medications can help reduce inflammation and swelling.
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 geographical areas of the country with high rates of methicillin-resistant S aureus (MRSA), alternative antimicrobial agents such as clindamycin or trimethoprim-sulfamethoxazole (TMP-SMZ) should be considered.
Dicloxacillin
Binds to 1 or more penicillin-binding proteins, which in turn inhibits synthesis of bacterial cell walls.
Adult
500 mg PO q6h
Pediatric
50 mg/kg/d PO divided q6h
Decreases efficacy of PO contraceptives; increases effects of anticoagulants; probenecid may increase levels
Documented hypersensitivity
Pregnancy
B - Fetal risk not confirmed in studies in humans but has been shown in some studies in animals
Precautions
Monitor prothrombin time (PT) in patients taking anticoagulant medications; toxicity may increase in renal impairment
Cephalexin (Keflex)
First-generation cephalosporin. Arrests bacterial growth by inhibiting bacterial cell-wall synthesis; provides bactericidal activity against rapidly growing organisms.
Adult
500 mg PO q6h
Pediatric
50 mg/kg/d PO divided q6h
Coadministration with aminoglycosides increases nephrotoxic potential
Documented hypersensitivity
Pregnancy
B - Fetal risk not confirmed in studies in humans but has been shown in some studies in animals
Precautions
Adjust dose in renal impairment
Nafcillin
Binds to 1 or more penicillin-binding proteins, which in turn inhibits synthesis of bacterial cell walls. Because of thrombophlebitis, administer parenterally for only 1-2 d; change to PO as clinically indicated.
Adult
2 g IV q4h
Pediatric
150 mg/kg/d IV divided q6h
Warfarin resistance when administered concurrently; effects may decrease with bacteriostatic action of tetracycline derivatives
Documented hypersensitivity
Pregnancy
B - Fetal risk not confirmed in studies in humans but has been shown in some studies in animals
Precautions
Thrombophlebitis
Cefazolin
First generation semi-synthetic cephalosporin that arrests bacterial cell-wall synthesis, inhibiting bacterial growth.
Adult
1 g IV q8h
Pediatric
20 mg/kg/dose IV q8h
Probenecid prolongs effect; coadministration with aminoglycosides may increase renal toxicity; may yield false-positive result urine dip test for glucose
Documented hypersensitivity
Pregnancy
B - Fetal risk not confirmed in studies in humans but has been shown in some studies in animals
Precautions
Adjust dose in renal impairment
Cefuroxime (Zinacef)
Second-generation cephalosporin that arrests bacterial cell-wall synthesis, inhibiting bacterial growth.
Adult
2.25-6 g/d IV q6-8h
Pediatric
50-100 mg/kg/d IV divided q6-8h
Disulfiram-like reactions may occur when alcohol consumed within 72 h after dose; may increase hypoprothrombinemic effects of anticoagulants; may increase nephrotoxicity in patient receiving potent diuretics (eg, loop diuretics); coadministration with aminoglycosides increase nephrotoxic potential
Documented hypersensitivity
Pregnancy
B - Fetal risk not confirmed in studies in humans but has been shown in some studies in animals
Precautions
Adjust dose in renal impairment
Ceftriaxone (Rocephin)
Third-generation cephalosporin arrests bacterial growth by binding to 1 or more penicillin-binding proteins.
Adult
1-2 g/d IV divided q12-24h
Pediatric
50-75 mg/kg/d IV divided q12-24h
Probenecid may increase levels; coadministration with ethacrynic acid, furosemide, or aminoglycosides may increase nephrotoxicity
Documented hypersensitivity
Pregnancy
B - Fetal risk not confirmed in studies in humans but has been shown in some studies in animals
Precautions
Adjust dose in renal impairment; caution in breastfeeding women and in persons with allergy to penicillin
Clindamycin (Cleocin)
Semisynthetic antibiotic produced by 7(S)-chloro-substitution of 7(R)-hydroxyl group of parent compound lincomycin. Inhibits bacterial growth, possibly by blocking dissociation of peptidyl transfer RNA (tRNA) from ribosomes, causing RNA-dependent protein synthesis to arrest. Widely distributes in the body without penetration of CNS. Protein bound and excreted by the liver and kidneys.
Used to treat serious skin and soft-tissue staphylococcal infections. Also effective against aerobic and anaerobic streptococci (except enterococci).
Adult
150-300 mg/dose PO q6-8h; not to exceed 1.8 g/d; alternatively, 600 mg IV divided q8h, depending on degree of infection; not to exceed 4.8 g/d
Pediatric
8-20 mg/kg/d PO as hydrochloride and 8-25 mg/kg/d as palmitate divided tid/qid; not to exceed 1.8 g/d
20-40 mg/kg/d IV/IM divided tid/qid; not to exceed 4.8 g/d
Increases duration of neuromuscular blockade induced by tubocurarine and pancuronium; erythromycin may antagonize effects; antidiarrheals may delay absorption
Documented hypersensitivity; regional enteritis, ulcerative colitis, hepatic impairment, antibiotic-associated colitis
Pregnancy
B - Fetal risk not confirmed in studies in humans but has been shown in some studies in animals
Precautions
Adjust dose in severe hepatic dysfunction; no adjustment necessary in renal insufficiency; associated with severe and possibly fatal colitis by allowing overgrowth of Clostridium difficile
Trimethoprim and sulfamethoxazole (TMP/SMZ, Bactrim, Septra)
Inhibits bacterial growth by inhibiting synthesis of dihydrofolic acid. Antibacterial activity includes common urinary-tract pathogens except Pseudomonas aeruginosa.
Adult
160 mg TMP/800 mg SMZ PO q12h for 10-14 d
Pediatric
<2 months: Do not administer
>2 months: 10-20 mg TMP/kg/d PO/IV divided tid/qid for 14 d
May increase PT with warfarin (perform coagulation tests and adjust dose accordingly); coadministration with dapsone may increase blood levels of both; coadministration of diuretics increases incidence of thrombocytopenia purpura in elderly; phenytoin levels may increase with coadministration; may potentiate effects of methotrexate in bone-marrow depression; hypoglycemic response to sulfonylureas may increase with coadministration; may increase levels of zidovudine
Documented hypersensitivity; megaloblastic anemia due to folate deficiency; age <2 months
Pregnancy
C - Fetal risk revealed in studies in animals but not established or not studied in humans; may use if benefits outweigh risk to fetus
D - Fetal risk shown in humans; use only if benefits outweigh risk to fetus
Precautions
Dosage adjustments (adult adjustments) for creatinine clearance (CrCl) 80-50 mL/min, recommended IV dosage is q18h; CrCl 50-10 mL/min, recommended IV dosage is q24h; CrCl <10 mL/min, not recommended; hemodialysis (HD), 4-5 mg/kg after HD; during peritoneal dialysis (PD), 0.16-0.8 g q48h
Discontinue at first appearance of skin rash or sign of adverse reaction; obtain CBCs frequently; discontinue if clinically significant hematologic changes occur; goiter, diuresis, and hypoglycemia may occur with sulfonamides; prolonged IV infusions or high doses may cause bone-marrow depression (if signs occur, give 5-15 mg/d leucovorin); caution in folate deficiency (chronic alcoholism, elderly, patients receiving anticonvulsant therapy or with malabsorption syndrome); hemolysis may occur in people with glucose-6-phosphate dehydrogenase (G-6-PD) deficiency; patients with AIDS may not tolerate or respond to TMP-SMZ; caution in renal or hepatic impairment (perform urinalyses and renal function tests during therapy); give fluids to prevent crystalluria and stone formation
More on Lymphangitis |
| Overview: Lymphangitis |
| Differential Diagnoses & Workup: Lymphangitis |
 Treatment & Medication: Lymphangitis |
| Follow-up: Lymphangitis |
| Multimedia: Lymphangitis |
| References |
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References
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Further Reading
Keywords
lymphangitis, lymphangeitis, lymphangiitis, lymphatic system, inflammation of the lymphatic channels, bacteremia, cellulitis, septic thrombophlebitis, superficial thrombophlebitis, necrotizing fasciitis, myositis, sporotrichosis, Staphylococcus aureus, Pseudomonas, Streptococcus pneumoniae, Pasteurella multocida, Aermonas hydrophila, treatment, diagnosis
