Intravenous to oral switch for septic jugular thrombophlebitis
For septic jugular thrombophlebitis (including infection associated with lung abscess), once the patient has improved, consider switching to oral therapy – for guidance on when to switch to oral therapy, see Guidance for intravenous to oral switch. A prolonged duration of intravenous therapy may be considered because of endovascular involvement – seek expert advice.
If oral continuation therapy is required for patients with septic jugular thrombophlebitis (including patients with associated lung abscess) in whom an anaerobic pathogen is identified, use:
amoxicillin+clavulanate 875+125 mg (child 2 months or older: 22.5+3.2 mg/kg up to 875+125 mg) orally, 8-hourly1. For dosage adjustment in adults with kidney impairment, see amoxicillin+clavulanate oral dosage adjustment. See below for duration of therapy. amoxicillin + clavulanate amoxicillin+clavulanate amoxicillin+clavulanate
For patients with hypersensitivity to penicillins, use:
clindamycin 450 mg (child: 10 mg/kg up to 450 mg) orally, 8-hourly; see below for duration of therapy. clindamycin clindamycin clindamycin
If metronidazole was added to clindamycin for initial intravenous therapy, or if the patient does not continue to improve with oral clindamycin monotherapy, consider adding metronidazole to clindamycin because of increasing resistance to clindamycin in gram-negative anaerobes (especially Bacteroides species). Consider adding to the oral clindamycin regimen:
metronidazole 400 mg (child: 10 mg/kg up to 400 mg) orally, 12-hourly; see below for duration of therapy. metronidazole metronidazole metronidazole