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:
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Dicloxacillin
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Cephalexin
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Cefazolin
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Cefuroxime
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Ceftriaxone
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Clindamycin
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Nafcillin
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Trimethoprim and sulfamethoxazole (TMP/SMZ)
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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Trypanosomal chancre on shoulder with lymphangitis toward axilla.
