Antibiotics for lymphadenitis

Inflammation of the lymph nodes can be purulent, and most often provoked by bacteria such as staphylococci and streptococci - therefore, it is impossible to imagine the treatment of this disease without antibiotic therapy. Antibiotics for lymphadenitis are prescribed depending on the stage of the inflammatory process and on the sensitivity of the bacterial flora in the infectious focus, while such medications are appropriate, both for nonspecific inflammation, and for specific (tuberculosis, gonorrhea, etc.).

Treatment of lymphadenitis with antibiotics

Reception of antibiotics is necessary for the acute form of the inflammatory process in the lymph nodes. And the sooner a doctor prescribes such drugs, the more effective the treatment will be.

Before prescribing an antibiotic, it is highly advisable to examine the contents of the node by making a bacteriological analysis. The essence of the study consists in puncturing and extracting a small amount of material. This procedure allows to determine the pathogen of the inflammatory process, for further precise orientation to the type of antibiotic. The only drawback of this manipulation is its duration, because not always the doctor has the time during which the disease can worsen. Therefore, a drug with the most extensive spectrum of antibacterial action is often prescribed.

The efficacy of an antibiotic prescribed for lymphadenitis is analyzed 3-4 days after the start of treatment. If the improvement does not occur, then the drug is changed to another.

Sometimes, with lymphadenitis, the principle of the stepwise approach is used: that is, during the first few days the antibiotic is administered as injections, and after the first improvements, they switch to taking the same drug, but already in tablet form.

Indications Antibiotics for lymphadenitis

A purulent inflammatory lesion can affect one lymph node, or the entire group of adjacent nodes. Most often, lymphadenitis affects these groups:

• parotid;
• cervical;
• submaxillary;
• axillary;
• inguinal.

Less often diagnosed elbow, popliteal, iliac and pelvic lymphadenitis.

Antibiotics are used to treat both specific and non-specific inflammatory processes - but only with the proven bacterial origin of the infection. Usually such infection is manifested by a short-term increase in the number of nodes that become painful, soft, hot to the touch.

Prolonged lymphadenitis (several months in a row) is often a sign of specific inflammatory processes - for example, tuberculosis or syphilis. The use of antibiotics is justified in this situation.

Do not use antibiotics for such lymphadenitis, which are associated with the following reasons:

• viral diseases;
• systemic autoimmune diseases;
• disturbed metabolism, endocrine pathology.

Enlarged lymph nodes do not always indicate the presence of an inflammatory process: sometimes this happens in malignant tumors. If there is a suspicion of such a pathology, antibiotics are also not needed: a cytological examination of the biological material from the site is performed, after which a treatment corresponding to pathology is prescribed.

[1], [2]

Release form

A number of the most common medicinal forms of antibiotics for lymphadenitis are known: tablets, capsules, solutions. Less commonly used suppository and syrups. Each of these forms differs in its "pluses" and "minuses":

Tablets and capsules	Their effectiveness often depends on the fullness of the stomach, on the quality of the digestive processes. Their application is technically simple and painless.
Solutions (injections)	This form has the greatest bioavailability and creates the fastest concentration of antibiotic in the blood. Injections can be painful. Execution of an injection can present some difficulties for the patient: the help of a medical specialist is required.
Candles	They are used mainly in pediatrics. There are difficulties in applying for diarrhea or dysbiosis.
Syrups	They are used mainly in children's practice. It is difficult to accurately dose the drug.

The choice of dosage form is performed by the doctor: he will be able to advise the most convenient antibiotic for lymphadenitis, both for adults or elderly patients, and for the child.

Titles

The most common with lymphadenitis are the antibiotics of the penicillin group - we are talking about Ampicillin, Ampiox, Amoxicillin (aka - Flemoxin). Such medicines are capable of destroying the structural wall of pathogenic microbes, what causes their death. Antibiotics of this group are not damaged by acidic gastric environment, so they can be prescribed not only injectively, but also in the form of tablets. By the way, tablets and capsules are especially in demand for the treatment of lymphadenitis in children.

Antibiotics of the penicillin group have a number of undeniable advantages over other similar drugs: they are low-toxic, hypoallergenic, do not tend to accumulate in the tissues of the body. To increase the effectiveness of penicillins, they are often combined with clavulanic acid preparations (complex medications Amoxiclav, Augmentin). Clavulanic acid protects the antibacterial agent from the damaging effects of bacterial enzymes.

Close on the action of penicillin drugs are antibiotics-macrolides. Macrolides perfectly cope with staphylococci, streptococci, which have resistance to penicillin agents. In the regimen of lymphadenitis therapy, antibiotics of the macrolide group such as Clarithromycin, Azithromycin, Sumamed can be included. They are prescribed in pediatrics and in adult practice.

Another suitable antibacterial group for lymphadenitis is cephalosporins. Most often, they are recommended for the treatment of lymph nodes in the neck and armpits. The most common cephalosporins are Ceftriaxone, Cephazoline, Cefuroxime, Cephalexin. The only possible disadvantage of antibiotics of this group is that they are used mainly in the form of injections, which is not always convenient and appropriate (especially in pediatric practice).

Among other antibacterial drugs, which are less commonly used for lymphadenitis, you can especially distinguish such drugs:

• aminoglycosides (Streptomycin, Gentamicin) - can be toxic, so if possible they are replaced with other antibiotics;
• tetracyclines - also have a certain degree of toxicity, so they are not used to treat children.

[3], [4], [5]

Pharmacodynamics

The clinical effect of antibiotics in lymphadenitis is determined by both the sensitivity of the bacteria to the drug and the distribution of the active substance in the tissues and body fluids. The degree of such distribution may change in patients with hepatic-cellular insufficiency, with impaired urinary function of the kidneys, etc. All this must be taken into account when prescribing an antibiotic.

The way the antibacterial substance behaves in the body depends on the metabolic features and the degree of binding to the plasma proteins. Effective therapeutic effect is possible only with good absorption of the drug. In addition, inside the body, the antibiotic is subjected to fermentation (metabolism), the input of which forms inactive, or even toxic products.

The mechanism of action of the selected preparation consists of three chronological stages: pharmaceutical, kinetic and dynamic.

At the pharmaceutical stage disintegration of the form of the drug is observed - this is dissolution, the output of the active component, absorption. The combination of an antibiotic with food and gastric juice can lead to a different degree of assimilation of the drug, down to its inactivation.

Tetracycline drugs, in addition to their toxicity, have the effect of binding to calcium (for example, with calcium contained in dairy products). Thus, with the presence of food in the stomach, the absorption of tetracyclines, penicillin, erythromycin, rifampicin, and other antibiotics is impaired.

Next, we consider the kinetic stage of the mechanism of action of the antibiotic, on which absorption, distribution, exchange, excretion of the active component takes place. It is in this period that the antibiotic acts directly on the pathogen. The stage continues from the moment the medicament is present in the bloodstream until it is removed from it.

When injecting an antibiotic solution, a faster contact with the pathogen and the penetration of the antibacterial component into the infectious focus are observed.

With subcutaneous or intramuscular injection, the rate of assimilation is proportional to the degree of solubility of the drug in the fluids.

At the dynamic stage, the antibiotic acts directly on the pathogenic microorganism against the background of achieving optimal biological activity. This stage can last from a couple of hours to several days (for example, if treatment is performed with antibiotics with prolonged action).

The effectiveness of therapy is determined by such factors:

• optimally selected form of antibiotic, ensuring maximum availability of the active substance;
• adequate dose of antibiotic;
• absence of bacterial resistance to the selected antibiotic.

The time intervals between taking medications, the total duration of antibiotic therapy also depend on pharmacokinetics and pharmacodynamics, which should always be remembered when prescribing a particular drug.

[6], [7]

Dosing and administration

The doctor can prescribe different antibiotics for lymphadenitis, depending on the situation - after all, the list of such medications is quite wide. We will consider only a few of the most common antibiotics that are appropriate for the treatment of this disease.

• Amoxiclav - this drug combines a couple of active ingredients, such as amoxicillin and clavulanic acid. Amoxiclav is the most relevant for the treatment of nonspecific lymphadenitis. The course of treatment with medication is 7-10 days, with the following dosages:
  • to children from 1 to 2 years old - 0.06 g;
  • children from 2 to 7 years old - 0.125 g;
  • children from seven to 12 years old - 0.25 g;
  • children from 12 years of age and adults - 0.3-0.5 g.

This amount of antibiotic is taken three times a day, after a meal.

• Benzylpenicillin - is used to treat specific lymphadenitis (for example, syphilitic). Benzylpenicillin is administered intramuscularly or intravenously:
  • children in the amount of 25-100 thousand units / kg of body weight, 2-4 times a day;
  • adults in the amount of 1-1.5 million units four times a day.

The duration of therapy with benzylpenicillin is determined individually.

• Clindamycin is a semisynthetic antibiotic, a representative of lincosamides and an analog of lincomycin. Clindamycin is taken orally after eating. The therapeutic course lasts no less than 10 days. Dosages can be as follows:
  • children - 0,003-0,006 g / kg of weight three times a day;
  • adults - 0.15 grams 4 times a day.
• Ceftriaxone is a synthetic antibiotic of a wide spectrum of activity. Ceftriaxone for lymphadenitis is administered intramuscularly:
  • children under 12 years in the amount of 0,02-0,08 g / kg of weight;
  • children from 12 years and adults in the amount of 1-2 g.

Antibiotic is administered once a day, for 7-10 days.

[15], [16], [17], [18], [19]

Antibiotics for submandibular lymphadenitis

Lymphadenitis with inflamed nodes in the neck and under the lower jaw is called cervical, or submaxillary. This kind of pathology is most easily detected, both to the doctor and to the patient himself, since this area is almost always open for review. Most often, this inflammation is caused by a nonspecific pathogen: streptococci, staphylococci, etc. The causes of the lesion are:

• inflammatory processes in the ENT organs;
• allergic processes;
• the disturbed metabolism with the phenomena of the general intoxication;
• connective tissue diseases;
• oncological disease;
• HIV infection.

With staphylococcal lymphadenitis with severe course, benzylpenicillin is used in the form of intramuscular or intravenous injections. Such therapy is continued until relief of acute signs of inflammation and normalization of temperature (usually 2-3 days are required for this). After this, the patient is transferred to the oral administration of penicillins:

• Benzylpenicillin 50 thousand IU / kg of weight per day;
• Phenoxymethylpenicillin 50 mg / kg per day.

The duration of treatment is adjusted by the doctor on an individual basis.

With staphylococcal lymphadenitis, semi-synthetic penicillins or cephalosporin preparations of the first generation are used. With moderate manifestations of lymphadenitis, antibiotics are administered orally, and in severe situations, intravenous administration of drugs is indicated.

Antibiotics for cervical lymphadenitis can be prescribed even before information on bacterioscopy and culture is obtained. In such a situation it is appropriate to prescribe penicillins that are resistant to penicillinase or cephalosporin drugs, since they are active against the most frequent pathogens of lymphadenitis - staphylococcus aureus and group A streptococci. Less commonly, lymphadenitis is caused by anaerobic bacteria that live in the oral cavity, or more less often - the bacterium Haemophilus influenzae type B.

[20], [21], [22], [23]

Antibiotics for lymphadenitis behind the ear

Inflammation of the nodes located behind the ear is called parotid lymphadenitis. The treatment of such a pathology is based on the elimination of its underlying cause. For example, for rubella or parotitis antiviral agents are used, and antibiotics are prescribed for inflammatory processes in the inner ear, in the ear canal, as well as in idiopathic lymphadenitis.

Optimum use of drugs with a wide range of antibacterial activity - for example, the use of semi-synthetic penicillins, macrolides, β-lactam antibiotics, representatives of the cephalosporin series is appropriate. Indicators of successful drug selection are such symptoms as a decrease in the volume of the lymph node, stihanie pain, stabilization of temperature indicators.

[24], [25], [26], [27]

Antibiotics for inguinal lymphadenitis

Inguinal lymphadenitis can develop after the penetration of the pathogen into the inguinal lymph nodes. In this case, the lymph node can be affected separately (primary lymphadenitis), or as a consequence of another disease (secondary lymphadenitis).

The basic reasons are usually:

• inflammatory processes in the pelvic organs, in the perineum;
• infectious diseases, sexually transmitted diseases;
• malignant processes.

The treatment scheme depends on many individual characteristics of the disease. Standard can be assigned to:

• Intravenous: Oxacillin or Methicillin 100-200 mg per kg per day (daily dose should be divided into equal injections every 4 hours), or Cefazolin at 80 mg per kg per day (the amount is divided and administered in the same parts every 8 hours).
• Orally: Dicloxacillin 25 mg per kg per day (for 4 divided doses) or Cefalexin 25-50 mg per kg per day (for 4 divided doses).

The duration of antibiotic therapy is determined depending on the dynamics of improvement: in most cases, 10 to 14 days are required.

[28], [29]

Antibiotics for axillary lymphadenitis

With axillary lymphadenitis, both antibiotics and immunity support are routinely prescribed. Among the most popular antibiotics are:

• Azithromycin is the representative of a new subgroup of macrolide antibiotics. At high concentrations, the drug has a bactericidal effect. Adults are recommended to take Azithromycin once a day (0.25-0.5 g), according to an individual scheme.
• Benzylpenicillin is an antibiotic that is obtained from the penicillin mold. The drug can be administered intravenously or intramuscularly. The course of treatment lasts 7-10 days (or more - according to the doctor's decision).
• Wilprafen (Josamycin) is a representative of a macrolide group. The recommended dose of antibiotic for an adult patient is 1-2 g for 2-3 doses. The duration of treatment is not less than 10 days.
• Amoxicillin is a semisynthetic antibiotic of a broad spectrum of activity, representing the penicillin series of drugs. The dose of the drug is determined individually, taking into account the severity of the inflammatory process and the sensitivity of the pathogen.
• Supraks (Cefixime) represents a number of semi-synthetic cephalosporin antibiotics of the third generation. The drug is provided for oral administration, it acts bactericidal. The average daily intake for adults is 400 mg. The duration of the treatment course is about 10 days.

[30], [31], [32], [33]

Antibiotics for children with lymphadenitis

Just as in adulthood, when prescribing an antibiotic for lymphadenitis in children, it is first necessary to find out the features of the disease: to clarify the cause, extent and stage of development of the inflammatory process. One condition must be strictly adhered to: there should not be any independent intake of antibiotics - especially in childhood.

Only the antibiotics of lymphadenitis in a child can not be cured, since it is necessary to work on the problem in a complex. The usual treatment regimen always consists of an antipyretic and anti-inflammatory drug, an immunomodulator, a multivitamin. If there is acute purulent lymphadenitis, then surgical intervention in the form of an opening or removal of the inflamed node can be prescribed.

If surgery is not required, most antibiotic patients with a wide range of activities such as Suprax, Flemoxin solute, Augmentin are prescribed to most small patients, both in tablet form and as a sweet syrup or suspension.

After an operative dissection of a purulent focus, a somewhat different complex treatment is prescribed:

• antibiotic therapy with Azithromycin, Cefotaxime;
• taking antihistamines (for example, Fenistil);
• taking non-steroidal anti-inflammatory drugs (eg, Ibuprofen);
• reception of vitamin complex preparations for children.

It should not be forgotten that lymphadenitis may indicate a pathological process above the lymph flow to the affected lymph nodes. Therefore, to conduct adequate treatment, it is necessary to establish the cause of the disease and eliminate it.

[34], [35], [36]

Use Antibiotics for lymphadenitis during pregnancy

In pregnancy, the risk of developing lymphadenitis is not less than in other circumstances, and even greater: because the immune defense in this period is significantly weakened. However, in the overwhelming majority of women, lymphadenitis becomes a complication of acute infectious diseases.

Despite a lot of precautions and inhibitions in pregnancy, lymphadenitis of bacterial origin is treated only with the help of antibiotics. For women in this situation, one of the most suitable and safe medicines is chosen, taking into account the condition and sensitivity of the microbes.

Preferably, antibiotics are prescribed:

• Ceftriaxone (excluding first trimester);
• Apmitsillin;
• Amoxiclav.

Of course, additional efficacy is also prescribed to enhance efficacy:

• anti-inflammatory drugs;
• vitamins;
• antihistamines;
• physiotherapy.

In no case should one practice self-medication: if a pregnant woman fulfills all medical purposes, lymphadenitis will be cured quickly, without unpleasant consequences for the mother herself and her unborn child.

Contraindications

Antibiotics for lymphadenitis are prescribed taking into account contraindications, the main of which is hypersensitivity to the selected group of antibacterial agents.

Semisynthetic antibiotics can be contraindicated in such diseases:

• Infectious mononucleosis;
• lymphocytic leukemia;
• impaired liver function;
• bronchial asthma;
• severe allergic diathesis;
• nonspecific ulcerative colitis.

With diagnosed decreased renal function and metabolic activity in elderly patients, the dose of antibiotics may require correction.

If the liver and / or kidneys are not working properly, cumulation of drugs can occur, which is taken into account by the doctor.

[8], [9], [10], [11]

Side effects Antibiotics for lymphadenitis

The use of antibiotics for lymphadenitis is sometimes accompanied by some side effects:

• Allergic processes that manifest themselves in the form of urticaria, redness, edema (including Quincke's edema), runny nose, inflammation of the conjunctiva. Less commonly, fever, joint pain, eosinophilia, and the most serious complication of anaphylactic shock can occur.
• Formation of superinfection in systemic treatment: fungal lesions of the oral cavity, vagina, intestinal dysbiosis.
• Digestive disorders: vomiting, nausea, diarrhea.
• Violations from the nervous system: increased reflex excitability, signs of meningism, convulsive conditions, coma. Neurotoxic manifestations can develop with the introduction of benzylpenicillin in large doses.
• Violation of blood clotting (bleeding syndrome).
• Water-electrolyte disorders in the form of hyponatremia, hypokalemia. Such signs often develop when taking antibiotics in excessively high doses.
• Disorders of the urinary system - the appearance of hematuria, proteinuria, the development of interstitial nephritis.
• Cholestatic jaundice - can be observed with combined administration of penicillins with clavulanic acid preparations (for example, Amoxiclav preparation).
• Burning and redness of the skin - with the injection of an antibiotic.

Why did the condition worsen with lymphadenitis from the antibiotic?

Antibiotics, which are used for lymphadenitis, have a common strong effect on the human body. Against the background of antibiotic therapy, many patients complain of a feeling of weakness, pain in the head, a state of malaise. Such symptoms can appear for several reasons:

• the immunity of the patient weakens - both because of illness, and because antibiotics destroy not only pathogenic, but also useful flora in the body;
• when microbial cells are destroyed, endotoxins accumulate in the blood: such a reaction may be accompanied by fever, general deterioration of well-being.

In addition, lymphadenitis can be a consequence of a viral infection. The causative agent in this situation is the influenza virus, cytomegalovirus, herpes simplex virus or the like. It is known that taking an antibiotic for lymphadenitis of viral origin is not advisable, since it can not destroy the pathogen, and the disease will progress. In such a case, there is a need for antiviral drugs.

[12], [13], [14]

Overdose

• An overdose of penicillin group antibiotics and cephalosporins is manifested by nausea with vomiting and diarrhea. With intravascular injection of an overestimated dose of penicillin, a convulsive condition may develop. If the patient suffers from kidney failure, then after the introduction of penicillin, hyperkalemia often develops, the signs of which are visible on the ECG. Large doses are also fraught with encephalopathy, mental abnormalities.
• With an overdose of tetracyclines, abdominal pain with nausea is observed. After the use of antibiotics with expired shelf life, it is possible to develop hypouricemia, hypokalemia.
• When an overdose of Levomycetin appears nausea with vomiting, loss of appetite, there are signs of respiratory failure. Less often during 5-12 hours after taking a large dose of antibiotic, acute signs of cardiac insufficiency are found.
• When an overdose of antibiotic-fluoroquinolones develops heart and / or renal failure, there is toxic damage to the liver, joint pains appear.

Treatment of overdose begins with the complete withdrawal of the drug and acceleration of its excretion from the body. Indispensable in this situation are osmotic diuretics and activated charcoal. If necessary, symptomatic treatment is prescribed.

The appearance of seizures is an occasion for prescribing diazepam, and with severe renal failure, it is possible to use hemodialysis or other methods for purifying blood.

[37], [38], [39]

Interactions with other drugs

The most popular antibiotics for lymphadenitis - penicillins - can not be prescribed in combination with allopurinol, because of the high risk of "ampicillin rash".

Antibacterial synergy is observed against the background of penicillins with macrolides or tetracyclines. Aminoglycosides with penicillins are combined only with oral intake: mixing these antibiotics in one syringe leads to loss of drug activity.

Before prescribing antibiotics for women of childbearing age, it is necessary to clarify whether they take oral contraceptives, as some drugs - for example, penicillins - are capable of interfering with their effectiveness. For the time of treatment with antibiotics, it is better for women to temporarily stop taking contraceptive pills, replacing them with barrier methods of contraception.

Penicillins avoid prescribing to patients who simultaneously take anticoagulants, antiaggregants and nonsteroidal anti-inflammatory drugs, because of the high risk of bleeding.

Macrolides are not used in combination with anti-acid agents (the effectiveness of antibiotic therapy is reduced). Also macrolide antibiotics are not offered together with amphenicol and lincosamides, statins.

[40], [41]

Storage conditions

Most antibiotics that are used for lymphadenitis are designed to be stored at normal room temperature - that is, + 15-22 ° C will be optimal. Sometimes the instruction indicates special conditions for the preservation of drugs - for example, a dry cool place (refrigerator) can be recommended for injectable solutions.

In the room, in darkened places, away from heating devices, antibacterial pills and capsules are usually stored.

Frozen medicines, as well as overheated in the sun or in a hot room, should not be used: such antibiotics can change their own properties and harm the patient with lymphadenitis.

[42], [43], [44],

Shelf life

The shelf-life of antibiotics used for lymphadenitis can usually be 2-3 years. This point is better specified in relation to a specific antibacterial drug.

The expiration date, which is prescribed on the package from the medication, can only correspond to reality if the adequate temperature regime specified in the annotation to the preparation was observed.

[45], [46], [47], [48], [49],

Lymphadenitis does not go away after a course of antibiotics: why?

Lymphadenitis can be bacterial, viral, allergic. This nature is determined by conducting preliminary analyzes - for example, a smear on the flora and sensitivity to antibiotics.

The virus type can not be treated with antibiotics - for this there are antiviral drugs. At an allergic lymphadenitis antibiotics also will not bring advantage - moreover, can also do much harm. In such situations, there will be no positive dynamics in the treatment of lymphadenitis, since the medications were initially prescribed incorrectly.

It happens that even with bacterial lymphadenitis, the antibiotic does not work - for example, if the microbes are insensitive to it. In a similar situation, it is necessary to pass the already mentioned analysis to the flora and sensitivity to antibiotics.

Is it possible to cure lymphadenitis without antibiotics?

Not always with lymphadenitis, it is advisable to use antibiotics. We have already mentioned that the disease can be viral or allergic in nature, and antibacterial agents are not prescribed in such situations.

The main reason for determining the need for antibiotic therapy is the cause of enlarged lymph nodes: it is established by examining the zone from which lymph flows to the affected nodes, and also by laboratory tests (OAK, test for infectious mononucleosis, anti-streptolysin titers, VDRL reaction, etc.). In this case, the most common method of diagnosis is a puncture with a node biopsy. The seized material is subjected to Gram staining, plated on a nutrient medium to determine cultures of aerobic and anaerobic microorganisms, as well as mycobacteria.

With lymphadenitis, provoked by atypical mycobacteria, antibiotics are in most cases not necessary: with aggravation of the disease, surgical treatment is performed with excision of the affected nodes. After the intervention, antimycobacterial agents are taken.

In other cases, antibiotics for lymphadenitis can be prescribed before the results of sowing and bacterioscopy are obtained if the situation requires urgent treatment. In a similar situation, use penicillin preparations, or other antibiotics that are active against the most common pathogens.