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