Lymphangitis medical therapy

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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.

Principles of Therapy

Therapy Based on Clinical Form

Acute Lymphangitis

Empiric Therapy

▸ Click on the following categories to expand treatment regimens.[1]

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 Suspected Methicillin-Sensitive Staphylococcus Aureus (MSSA)
Dicloxacillin 500 mg PO q6h
OR
Cephalexin 500 mg PO q6h
For Suspected Methicillin-Resistant Staphylococcus Aureus (MRSA)
Clindamycin 300-450 mg PO q8h
OR
TMP-SMZ 1 or 2 double-strength tablets ((sulfamethoxazole 800 mg; trimethoprim 160 mg) PO q12h
OR
Doxycycline 100 mg PO q12h
OR
Minocycline 100 mg PO q12h
OR
Linezolid 600 mg PO q12h
For Suspected Beta-Hemolytic Streptococci and Methicillin-Resistant Staphylococcus Aureus (MRSA) Clindamycin 300-450 mg PO q8h
OR
Amoxicillin 500 mg PO q8h plus TMP-SMZ 1 or 2 double-strength tablets ((sulfamethoxazole 800 mg; trimethoprim 160 mg) PO q12h
OR
Amoxicillin 500 mg PO q8h plus Doxycycline 100 mg PO q12h
OR
Amoxicillin 500 mg PO q8h plus Minocycline 100 mg PO q12h
OR
Linezolid 600 mg PO q12h
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 Suspected Methicillin-Sensitive Staphylococcus Aureus (MSSA)
Dicloxacillin 25 mg/kg PO divided q6h
OR
Cephalexin 25 mg/kg PO divided q6h
For Suspected Methicillin-Resistant Staphylococcus Aureus (MRSA)
Clindamycin 10-13 mg/kg PO q6-8h
OR
TMP-SMZ 8–12 mg/kg (based on trimethoprim component) PO q12h
OR
Doxycycline ≤45 kg: 2 mg/kg PO q12h; >45 kg: 100 mg PO q12h
OR
Minocycline 2 mg/kg PO q12h
OR
Linezolid 10 mg/kg PO q8h
For Suspected Beta-Hemolytic Streptococci and Methicillin-Resistant Staphylococcus Aureus (MRSA) Clindamycin 10-13 mg/kg PO q6-8h
OR
Amoxicillin 25-50 mg/kg PO q8h plus TMP-SMZ 8–12 mg/kg (based on trimethoprim component) PO q12h
OR
Amoxicillin 25-50 mg/kg PO q8h plus Doxycycline ≤45 kg: 2 mg/kg PO q12h; >45 kg: 100 mg PO q12h
OR
25-50 mg/kg PO q8h plus Minocycline 2 mg/kg PO q12h
OR
Linezolid 10 mg/kg PO q8h
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 Methicillin-Sensitive Staphylococcus Aureus (MSSA)
Nafcillin or Oxacillin 1-2 g IV q4h
OR
Cefazolin 1 g IV q8h
OR
Clindamycin 300-450 mg PO q8h
OR
Erythromycin 500 mg PO q6h
For Suspected Methicillin-Resistant Staphylococcus Aureus (MRSA)
Vancomycin 15-20 mg/kg IV q8-12h
OR
Linezolid 600 mg IV q12h
OR
Daptomycin 4mg/kg IV q24h
OR
Clindamycin 600 mg IV/PO q8h
OR
Telavancin 10 mg/kg IV q12h
For Suspected Beta-Hemolytic Streptococci and Methicillin-Resistant Staphylococcus Aureus (MRSA) Clindamycin 300-450 mg PO q8h
OR
Amoxicillin 500 mg PO q8h plus TMP-SMZ 1 or 2 double-strength tablets ((sulfamethoxazole 800 mg; trimethoprim 160 mg) PO q12h
OR
Amoxicillin 500 mg PO q8h plus Doxycycline 100 mg PO q12h
OR
Amoxicillin 500 mg PO q8h plus Minocycline 100 mg PO q12h
OR
Linezolid 600 mg PO q12h
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 Methicillin-Sensitive Staphylococcus Aureus (MSSA)
Nafcillin or Oxacillin 100–150 mg/kg IV q6h
OR
Cefazolin 50 mg/kg IV q8h
OR
Clindamycin 10-13 mg/kg IV q6-8h
OR
Erythromycin 10 mg/kg PO q6h
For Suspected Methicillin-Resistant Staphylococcus Aureus (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)
For Suspected Beta-Hemolytic Streptococci and Methicillin-Resistant Staphylococcus Aureus (MRSA) Clindamycin 10-13 mg/kg PO q6-8h
OR
Amoxicillin 25-50 mg/kg PO q8h plus TMP-SMZ 8–12 mg/kg (based on trimethoprim component) PO q12h
OR
Amoxicillin 25-50 mg/kg PO q8h plus Doxycycline ≤45 kg: 2 mg/kg PO q12h; >45 kg: 100 mg PO q12h
OR
25-50 mg/kg PO q8h plus Minocycline 2 mg/kg PO q12h
OR
Linezolid 10 mg/kg PO q8h
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.[1]

Bacteria

  ▸  Streptococcus Pyogenes

  ▸  Methicillin Sensitive Staphylococcus Aureus

  ▸  Methicillin Resistant Staphylococcus Aureus

  ▸  Spirillum Minus

Parasite

  ▸  Brugia Malayi

  ▸  Wuchereria Bancrofti

Streptococcus Pyogenes
Preferred Regimen
Penicillin V 500 mg PO q6h or Penicillin G 2-4 MU IV q4-6h
Alternative Regimen
For Life-Threatening Penicillin Allergies
Adults
Clindamycin 300-450 mg PO q8h
OR
Vancomycin 15-20 mg/kg IV q8-12h
Children age >28 days
Clindamycin 10-13 mg/kg IV q6-8h
OR
Vancomycin 15 mg/kg IV q6h
Methicillin-Sensitive Staphylococcus Aureus (MSSA) Preferred Regimen
Adults
Nafcillin or Oxacillin 1-2 g IV q4h
OR
Cefazolin 1 g IV q8h
OR
Clindamycin 300-450 mg PO q8h or 600 mg/kg IV q8h
OR
Erythromycin 500 mg PO q6h
OR
Dicloxacillin 500 mg PO q6h
OR
Cephalexin 500 mg PO q6h
OR
Doxycycline or Minocycline 100 mg PO q12h
OR
TMP-SMZ 1 or 2 double-strength tablets ((sulfamethoxazole 800 mg; trimethoprim 160 mg) PO q12h
Children age >28 days
Nafcillin or Oxacillin 100–150 mg/kg IV q6h
OR
Cefazolin 50 mg/kg IV q8h
OR
Clindamycin 10–20 mg/kg PO q8h or 25–40 mg/kg IV q8h
OR
Erythromycin 10 mg/kg PO q6h
OR
Dicloxacillin 25 mg/kg PO q6h
OR
Cephalexin 25 mg/kg PO q6h
OR
TMP-SMZ 8–12 mg/kg (based on trimethoprim component) IV q6h/PO q12h
Methicillin-Resistant Staphylococcus Aureus (MRSA) Preferred Regimen
Adult
Vancomycin 30 mg/kg IV q12h
OR
Linezolid 600 mg IV/PO q12h
OR
Clindamycin 300-450 mg PO q8h or 600 mg/kg IV q8h
OR
Daptomycin 4mg/kg IV q24h
OR
Doxycycline or Minocycline 100 mg PO q12h
OR
TMP-SMZ 1 or 2 double-strength tablets ((sulfamethoxazole 800 mg; trimethoprim 160 mg) PO q12h
Children age >28 days
Vancomycin 40 mg/kg IV q6h
OR
Linezolid 10 mg/kg IV/PO q12h
OR
Clindamycin 10–20 mg/kg PO q8h or 25–40 mg/kg IV q8h
OR
TMP-SMZ 8–12 mg/kg (based on trimethoprim component) IV q6h/PO q12h
For Suspected MRSA
Adult
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
Children age >28 days
For Animal Bites
Adult
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
Children age >28 days


References

  1. 1.0 1.1 Moran GJ, Abrahamian FM, Lovecchio F, Talan DA (2013). "Acute bacterial skin infections: developments since the 2005 Infectious Diseases Society of America (IDSA) guidelines". J Emerg Med. 44 (6): e397–412. doi:10.1016/j.jemermed.2012.11.050. PMID 23466022.

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