Penicillin hypersensitivity regimens for septic jugular thrombophlebitis in adults and children

Empirical regimens are included below for adults and children with septic jugular thrombophlebitis (including those with associated lung abscess) who have had a hypersensitivity reaction to a penicillin. Use these empirical regimens while awaiting the results of culture and susceptibility testing.

For adults and children who have had a nonsevere (immediate or delayed) hypersensitivity reaction to a penicillin, use the ceftriaxone- or cefotaxime-based regimens, with or without vancomycin. For dosages, see the standard regimen for adults or children.

For adults and children who have had a severe immediate¹ hypersensitivity reaction to a penicillin:

the ceftriaxone- or cefotaxime-based regimens can be considered if a beta-lactam antibiotic is strongly preferred (for considerations, see Severe immediate hypersensitivity: Implications of cross-reactivity between penicillins and cephalosporins) – for dosages, see the standard regimen for adults or children
use the non–beta-lactam regimens below (as for patients with a severe delayed hypersensitivity reaction) for patients in whom the ceftriaxone- or cefotaxime-based regimens are not used.

For adults and children who have had a severe delayed² hypersensitivity reaction to a penicillin, empirical regimens are included for:

¹ Severe immediate hypersensitivity reactions include anaphylaxis, compromised airway, airway angioedema, hypotension and collapse.Return

² Severe delayed hypersensitivity reactions include cutaneous adverse drug reactions (eg drug rash with eosinophilia and systemic symptoms [DRESS], Stevens–Johnson syndrome/toxic epidermal necrolysis [SJS/TEN], severe blistering or desquamative rash), and significant internal organ involvement (eg acute interstitial nephritis).Return