Approach Considerations
Patients with lymphangitis should be treated with an appropriate antimicrobial agent. [10] 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 antibiotics in an outpatient setting. Adult patients who appear nontoxemic, are afebrile, and well hydrated may also be treated initially with oral antibiotics in an outpatient setting. Ensure close follow-up.
Parenteral antibiotics may be required for patients with signs of systemic illness (eg, fever, chills and myalgia, lymphangitis).
Aggressively treat patients who are suspected of having group A beta-hemolytic streptococcus infection; 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 to reduce inflammation and swelling. Hot, moist compresses also help to reduce inflammation and pain.
If possible, elevate and immobilize affected areas to reduce swelling, pain, and the spread of infection. An abscess may require surgical drainage.
Prevention
Guidelines to prevent transmission of methicillin-resistant S aureus have been established. [11]
Nodular lymphangitis
Treatment of nodular lymphangitis is determined by identifying the underlying cause. Sporotrichosis is most often identified in this disease and is commonly found among gardeners.
Inpatient Care
Some patients with lymphangitis may require admission for intravenous (IV) antimicrobial therapy. Most authors recommend that children younger than 3 years or children who are febrile and who appear toxic initially be treated with IV antibiotics.
Children who have not improved clinically after 48 hours of appropriate oral antimicrobial therapy should receive IV antistaphylococcal and antistreptococcal therapy. When erythema, warmth, and edema are markedly reduced, oral antibiotics can be used.
Adults who are febrile and appear toxic should be initially treated with IV antibiotics.
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Trypanosomal chancre on shoulder with lymphangitis toward axilla.
