Wednesday, July 12, 2017

Thrombophlebitis : Rationale for Antibiotics

Peripheral Thrombophlebitis
  • Staph. aureus, Coagulase negative Staphylococcus, Gram negative rods
  • Remove the intravenous canulla and take blood culture
  • Peripheral intravenous catheters with associated pain, induration, erythema, or exudate should be removed
  • Any exudate at the insertion site should be submitted for Gram staining, routine culture, and additional culture for fungi and acid-fast organisms, as indicated, when assessing immunocompromised patients
  • recommend : Cloxacillin 500 mg PO q6h
Superficial Thrombophlebitis
  • Superficial thrombophlebitis refers to erythema, pain, induration, and other findings of inflammation in superficial veins, usually due to infection or thrombosis
  • These agents are not routinely useful in nonseptic superficial phlebitis
  • choice of antibiotics should be guided by blood culture results whenever possible, but empiric therapy should at a minimum provide coverage for group A streptococci and for Staphylococcus aureus
  • Ceftriaxone
    • 1 to 2 g IV or IM once a day (or in equally divided doses twice a day)
      Duration of therapy: 4 to 14 days
      -Complicated infections: Longer therapy may be required.
  • Cephalexin
    • Skin/Skin Structure Infections
    • 250 mg PO q6hr or 500 mg PO q12hr; dosage range, 1-4 g/day in divided doses
    • Cellulitis and Mastitis
    • 500 mg PO q6hr; dosage range, 1-4 g/day in divided doses
References:
  1. http://emedicine.medscape.com/article/463256-medication#4
  2. Clinical Practice Guidelines for the Diagnosis and Management of Intravascular Catheter-Related Infection: 2009 Update by the Infectious Diseases Society of America
  3. National Antibiotic Guideline 2014

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