Standard regimen for septic jugular thrombophlebitis in adults

For initial management of adults with septic jugular thrombophlebitis (including those with associated lung abscess), while awaiting the results of culture and susceptibility testing, useMoretti, 2021:

1amoxicillin+clavulanate 2+0.2 g intravenously, 8-hourly. For dosage adjustment in adults with kidney impairment, see amoxicillin+clavulanate intravenous dosage adjustment. See advice on modification and duration of therapy amoxicillin + clavulanate amoxicillin+clavulanate amoxicillin+clavulanate

1amoxicillin+clavulanate 1+0.2 g intravenously, 6-hourly. For dosage adjustment in adults with kidney impairment, see amoxicillin+clavulanate intravenous dosage adjustment. See advice on modification and duration of therapy amoxicillin + clavulanate amoxicillin+clavulanate amoxicillin+clavulanate

OR as a 2-drug regimen

1metronidazole 500 mg intravenously, 12-hourly. See advice on modification and duration of therapy metronidazole metronidazole metronidazole

PLUS

ceftriaxone 2 g intravenously, daily. For adults with septic shock or requiring intensive care support, use ceftriaxone 1 g intravenously, 12-hourly. See advice on modification and duration of therapy. ceftriaxone ceftriaxone ceftriaxone

For adults with septic shock, add to the above regimens:

vancomycin 25 mg/kg (actual body weight) rounded up to nearest 125 mg, up to 3 g intravenously, as a loading dose. See Calculated vancomycin loading dosage in critically ill adults for calculated weight-based loading doses. Subsequent doses are dependent on weight and kidney function; see Intermittent vancomycin dosing for critically ill adults. See advice on modification and duration of therapy. vancomycin vancomycin vancomycin

Pharmacokinetics may be altered in adults who are critically ill (eg because of enhanced kidney clearance or changes in volume of distribution). To ensure adequate drug exposure in adults with septic jugular thrombophlebitis who have septic shock or require intensive care support, a modified dosage of ceftriaxone is recommended. Once the critical illness has resolved, consider switching to the standard dosage.