From the Guidelines
For cervical lymphadenitis, the primary treatment approach is surgical excision, with a greater than 90% cure rate, and a macrolide-based regimen should be considered for patients with extensive disease or poor response to surgical therapy. The most common causative organisms of cervical lymphadenitis are Mycobacterium avium complex (MAC) 1. When considering antibiotic therapy, the treatment regimen for NTM cervical lymphadenitis is based on the causative organism, with MAC being the most common cause 1. Key points to consider in treatment include:
- Surgical excision is the primary treatment approach for NTM cervical lymphadenitis 1
- A macrolide-based regimen, such as clarithromycin or azithromycin, should be considered for patients with extensive disease or poor response to surgical therapy 1
- The treatment regimen should be individualized based on the patient's response to therapy and the causative organism 1
- Patients should be closely monitored for clinical improvement and potential complications, such as abscess formation or spread to deeper tissues 1.
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
Antibiotics Used to Treat Cervical Lymphadenitis
- The most common bacterial etiologies of cervical lymphadenitis are Staphylococcus aureus and Streptococcus pyogenes 2, 3
- A single antibiotic that treats S. pyogenes and S. aureus should be the empiric antibiotic for cervical lymphadenitis requiring incision and drain 2
- Clindamycin is effective against methicillin susceptible S. aureus (MSSA) and methicillin resistant S. aureus (MRSA) 2
- First-generation cephalosporins, such as cefazolin, are effective against MSSA and can be used as empiric treatment for acute bacterial lymphadenitis 3
- Ampicillin-sulbactam is a commonly used broad-spectrum agent, but may not be necessary for the treatment of cervical lymphadenitis 3
- Clarithromycin and rifabutin can be used to treat nontuberculous mycobacterial cervicofacial lymphadenitis, but surgical excision is more effective than antibiotic therapy 4
Surgical Treatment
- Surgical excision is more effective than antibiotic treatment for children with nontuberculous mycobacterial cervicofacial lymphadenitis 4
- Selective cervical lymphadenectomy can be used to treat nontuberculous mycobacterial cervical lymphadenitis and can serve both diagnostic and therapeutic purposes 5
- Incision, drainage, and puncture should be deferred to avoid the development of fistulae and secondary surgical procedures 5