How is internal jugular thrombophlebitis treated?

Updated: Oct 05, 2021
  • Author: JE Robyn Hanna, MD, MS; Chief Editor: Jeter (Jay) Pritchard Taylor, III, MD  more...
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Answer

In the case of Lemierre syndrome, particular attention should be paid to covering anaerobic infections especially F necrophorum, as well as streptococci and Bacteroides species. Empiric antibiotic therapy should include a beta-lactamase–resistant B-lactam to cover F necrophorum since penicillin failure has been reported. [41] Ampicillin-sulbactam, piperacillin-tazobactam, or a carbapenem are all good choices. Duration of intravenous therapy is prolonged, for a duration of at least 3-4 weeks.

The role of anticoagulation in infected jugular vein thrombosis is controversial. [12] Catheter-directed thrombolysis may be an option. [42]

Incision and drainage of adjacent peritonsillar abscess should be performed promptly by an otolaryngological surgeon or trained ED specialist. [10] Surgical resection of infected thrombus is generally reserved in case conservative management fails.


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