Patients who have had a severe delayed hypersensitivity reaction to a penicillin and do not have septic shock

For adults and children with septic jugular thrombophlebitis (including those with associated lung abscess) who have had a severe delayed¹ hypersensitivity reaction to a penicillin and do not have septic shock, use:

clindamycin 600 mg (child: 15 mg/kg up to 600 mg) intravenously, 8-hourly; see advice on modification and duration of therapy ². clindamycin clindamycin clindamycin

For adults and children who do not have septic shock and are not improving with intravenous clindamycin, consider adding metronidazole because of increasing resistance to clindamycin in gram-negative anaerobes (especially Bacteroides species). Add to the clindamycin regimen above:

metronidazole 500 mg (child: 12.5 mg/kg up to 500 mg) intravenously, 12-hourly; see advice on modification and duration of therapy. metronidazole metronidazole metronidazole

¹ 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

² There are more clinical and microbiological data to support the use of clindamycin than lincomycin. Intravenous lincomycin can be used at the same dosage if clindamycin is unavailable or if a local protocol recommends its use.Return