What antibiotics are used to treat lymphadenitis?

From the Guidelines

For lymphadenitis, empiric antibiotic therapy should target the most likely causative organisms, primarily Staphylococcus aureus and Streptococcus species, with first-line treatment being oral cephalexin 500 mg four times daily for 7-10 days, as recommended by the most recent guidelines 1. The choice of antibiotic is crucial in managing lymphadenitis, and the most recent evidence suggests that cephalexin is a suitable first-line option 1.

• For adults, the recommended dose is 500 mg four times daily for 7-10 days.
• For children, the appropriate dosing would be 25-50 mg/kg/day divided into four doses. In patients with penicillin allergy, clindamycin 300-450 mg orally four times daily for adults (or 10-30 mg/kg/day divided into three or four doses for children) is recommended 1. If MRSA is suspected, consider trimethoprim-sulfamethoxazole or doxycycline (for patients ≥8 years old) 1. More severe cases requiring hospitalization may need intravenous antibiotics like nafcillin, oxacillin, or vancomycin 1. Treatment should be adjusted based on culture results when available 1. Lymphadenitis often resolves with appropriate antibiotic therapy, but persistent or recurrent lymphadenitis may require surgical drainage or further investigation for underlying causes such as tuberculosis, cat-scratch disease, or malignancy. The most recent guidelines from the WHO Essential Medicines and Aware recommendations support the use of cephalexin as a first-line treatment for skin and soft tissue infections, including lymphadenitis 1. It is essential to note that the treatment should be tailored to the individual patient's needs and adjusted based on culture results and clinical response.

From the FDA Drug Label

The FDA drug label does not answer the question.

From the Research

Antibiotics Used to Treat Lymphadenitis

• The most common antibiotics used to treat lymphadenitis include:
  • Ampicillin-sulbactam 2
  • Cefazolin 2
  • Flucloxacillin 3
  • First-generation cephalosporins 2, 3
  • Clindamycin 3, 4
  • Cephalexin 5

Bacterial Etiology of Lymphadenitis

• The predominant pathogens causing lymphadenitis are:
  • Staphylococcus aureus 2, 3, 6, 4
  • Streptococcus pyogenes 2, 3, 6, 4
• Methicillin-resistant S. aureus (MRSA) is also a concern, particularly in cases where empiric antibiotic therapy is not effective 3, 6, 4

Treatment Approaches

• Uncomplicated lymphadenitis can be managed with narrow-spectrum beta-lactam therapy, such as flucloxacillin 3
• Complicated disease may require broader-spectrum antibiotics, such as clindamycin, and early imaging and surgical intervention 3
• The choice of antibiotic should be guided by local resistance patterns and the results of microbiological cultures 2, 6, 4