Which medications in the drug class Antibiotics are used in the treatment of Septic Thrombophlebitis?

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

Antibiotics

Antibiotics are initially chosen empirically and should be based on the location of the infected thrombus as detailed above. Broad coverage is generally warranted until blood cultures taken from the suppurative vessel have results, at which point deescalation of microbial coverage is appropriate. Because many infections are caused by S aureus, coverage of MRSA should routinely be administered in most cases on initial patient presentation.

Vancomycin

Vancomycin is an antibiotic directed against gram-positive organisms and active against Enterococcus species as well as community-acquired and hospital-acquired MRSA.

Ceftriaxone (Rocephin)

Ceftriaxone is a third-generation cephalosporin with broad-spectrum, gram-negative activity. It has less gram-positive coverage than earlier-generation cephalosporins. It is bactericidal and inhibits cell wall synthesis by binding to penicillin-binding proteins.

Cefepime (Maxipime)

Cefepime is a fourth-generation cephalosporin with coverage similar to ceftriaxone, with the added benefit of pseudomonal coverage.

Clindamycin (Cleocin)

Clindamycin is a lincosamide used for the treatment of serious skin and soft-tissue staphylococcal infections. It is also effective against aerobic and anaerobic streptococci (except enterococci). Clindamycin inhibits bacterial growth, possibly by blocking dissociation of peptidyl transfer ribonucleic acid (tRNA) from ribosomes, causing RNA-dependent protein synthesis to arrest.

Ampicillin-sulbactam (Unasyn)

Ampicillin-sulbactam is ampicillin plus a beta-lactamase inhibitor. It interferes with cell wall synthesis during active replication, causing bactericidal activity. It covers skin, enteric flora, and anaerobes.

Piperacillin and tazobactam sodium (Zosyn)

This is an antipseudomonal penicillin plus a beta-lactamase inhibitor. It inhibits the biosynthesis of cell wall mucopeptide and is effective during the stage of active multiplication.

Imipenem-cilastatin (Primaxin)

Imipenem is a carbapenem. It inhibits bacterial cell wall synthesis by binding to penicillin-binding proteins. Cilastatin prevents renal metabolism. It has excellent gram-negative (including pseudomonal) and anaerobic coverage.

Metronidazole (Flagyl)

Metronidazole is an imidazole ring-based antibiotic that is particularly active against various anaerobic bacteria and protozoa.

Fluconazole (Diflucan)

Fluconazole is a selective inhibitor of fungal cytochrome P-450 dependent enzyme. It has fungistatic activity against many candidal species.

Amphotericin B liposomal (AmBisome)

Amphotericin B, which is produced by a strain of Streptomyces nodosus, can be fungistatic or fungicidal (effective against candidal phlebitis). It binds to sterols, such as ergosterol, in the fungal cell membrane, causing intracellular components to leak, with subsequent fungal cell death.


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