Antibiotics for lymphadenitis

Inflammation of the lymph nodes can be purulent, and is 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 the sensitivity of the bacterial flora in the infectious focus, while such medications are appropriate for both non-specific inflammation and specific inflammation (tuberculosis, gonorrhea, etc.).

Treatment of lymphadenitis with antibiotics

Taking antibiotics is necessary in the acute form of the inflammatory process in the lymph nodes. And the sooner the 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 performing a bacteriological analysis. The essence of the study is a puncture and extraction of a small amount of material. This procedure allows you to determine the causative agent of the inflammatory process, for further precise orientation on the type of antibiotic. The only disadvantage of this manipulation is its duration, because the doctor does not always have time during which the disease can worsen. Therefore, a drug with the widest possible spectrum of antibacterial action is often prescribed.

The effectiveness of the antibiotic prescribed for lymphadenitis is analyzed 3-4 days after the start of treatment. If there is no improvement, the drug is replaced with another one.

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

Indications antibiotics for lymphadenitis.

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

• parotid;
• cervical;
• submandibular;
• axillary;
• inguinal.

Less frequently diagnosed are ulnar, popliteal, iliac and pelvic lymphadenitis.

Antibiotics are used to treat both specific and non-specific inflammatory processes, but only if the bacterial origin of the infection is proven. Typically, such an infection manifests itself as a short-term increase in a group of nodes that become painful, soft, and hot to the touch.

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

Antibiotics are not used for lymphadenitis that is associated with the following causes:

• viral diseases;
• systemic autoimmune diseases;
• metabolic disorders, endocrine pathologies.

Enlarged lymph nodes do not always indicate the presence of an inflammatory process: sometimes this happens with malignant tumors. If such a pathology is suspected, antibiotics are also not needed: a cytological study of biological material from the node is carried out, after which treatment corresponding to the pathology is prescribed.

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Release form

There are a number of the most common dosage forms of antibiotics for lymphadenitis - these are tablets, capsules, solutions. Suppositories and syrups are used less often. Each of the listed forms has its own "pros" and "cons":

Tablets and capsules	Their effectiveness often depends on the fullness of the stomach and the quality of digestive processes. Their use is technically simple and painless.
Solutions (injections)	This form has the highest bioavailability and creates the fastest possible concentration of the antibiotic in the blood. Injections may be painful. Performing an injection may present some difficulties for the patient himself: the assistance of a medical specialist is required.
Candles	They are used mainly in pediatrics. Difficulties arise in use in cases of diarrhea or dysbacteriosis.
Syrups	They are used mainly in pediatric practice. It is difficult to accurately dose the drug.

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

Names

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

Antibiotics of the penicillin group have a number of undeniable advantages over other similar drugs: they are low-toxic, hypoallergenic, and do not tend to accumulate in body tissues. 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.

Macrolide antibiotics are considered to be close in action to penicillin drugs. Macrolides cope well with staphylococci, streptococci, which are resistant to penicillin drugs. The treatment regimen for lymphadenitis can include such macrolide antibiotics as Clarithromycin, Azithromycin, Sumamed. They are prescribed both in pediatrics and in adult practice.

Another suitable antibacterial group for lymphadenitis is cephalosporins. Most often, they are recommended for the treatment of lesions of the lymph nodes of the neck and armpits. The most common cephalosporins are Ceftriaxone, Cefazolin, Cefuroxime, Cephalexin. The only possible disadvantage of antibiotics in 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 medications that are used less frequently for lymphadenitis, the following drugs can be especially distinguished:

• 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.

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Pharmacodynamics

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

The way an antibacterial substance behaves in the body depends on its metabolic characteristics and the degree of binding to plasma proteins. Effective therapeutic action is possible only with good absorption of the drug. In addition, the antibiotic undergoes fermentation (metabolism) inside the body, during which inactive or even toxic products are formed.

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

At the pharmaceutical stage, the disintegration of the drug form is observed - this is dissolution, release of the active component, absorption. The combination of an antibiotic with food and gastric juice can lead to varying degrees of absorption of the drug, up to its inactivation.

Tetracycline drugs, in addition to their toxicity, have the effect of binding to calcium (for example, 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 will consider the kinetic stage of the mechanism of action of the antibiotic, during which absorption, distribution, exchange, and excretion of the active component occur. It is during this period that the antibiotic directly affects the pathogen. The stage continues from the moment the drug is present in the bloodstream until it is excreted from it.

When an antibiotic solution is injected, there is faster contact with the pathogen and penetration of the antibacterial component into the infectious site.

With subcutaneous or intramuscular administration, the rate of absorption is proportionally dependent on the degree of solubility of the drug in liquids.

At the dynamic stage, the antibiotic directly affects the pathogenic microorganism while achieving optimal biological activity. This stage can last from a couple of hours to several days (for example, if the treatment is carried out with prolonged-action antibiotics).

The effectiveness of therapy is determined by the following factors:

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

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

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Dosing and administration

The doctor may 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 pair of active components, such as amoxicillin and clavulanic acid. Amoxiclav is most relevant for the treatment of non-specific lymphadenitis. The course of treatment with the drug is 7-10 days, with the following dosages:
  • for 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;
  • for children over 12 years of age and adult patients – 0.3-0.5 g.

The specified amount of antibiotic is taken three times a day, after meals.

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

The duration of therapy with Benzylpenicillin is determined individually.

• Clindamycin is a semi-synthetic antibiotic, a representative of lincosamides and an analogue of lincomycin. Clindamycin is taken orally, after meals. The therapeutic course lasts at least 10 days. Dosages may be as follows:
  • children – 0.003-0.006 g/kg of weight three times a day;
  • adults – 0.15 g 4 times a day.
• Ceftriaxone is a synthetic antibiotic with a broad spectrum of activity. Ceftriaxone is administered intramuscularly for lymphadenitis:
  • for children under 12 years of age in the amount of 0.02-0.08 g/kg of body weight;
  • for children over 12 years of age and adults in the amount of 1-2 g.

The antibiotic is administered once a day for 7-10 days.

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Antibiotics for submandibular lymphadenitis

Lymphadenitis with inflamed nodes in the neck and under the lower jaw is called cervical or submandibular. This type of pathology is easiest to detect, both for the doctor and the patient, since this area is almost always open for viewing. Most often, such inflammation is caused by a non-specific pathogen: streptococci, staphylococci, etc. The causes of the lesion are:

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

In severe staphylococcal lymphadenitis, Benzylpenicillin is used in the form of intramuscular or intravenous injections. This therapy is continued until the acute signs of inflammation are relieved and the temperature is normalized (usually 2-3 days). After this, the patient is transferred to oral penicillin:

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

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

In case of staphylococcal lymphadenitis, semi-synthetic penicillins or first-generation cephalosporin drugs are used. In case of moderate manifestations of lymphadenitis, antibiotics are prescribed orally, and in severe cases, intravenous administration of drugs is indicated.

Antibiotics for cervical lymphadenitis may be prescribed even before receiving information from bacterioscopy and culture. In such a situation, it is appropriate to prescribe penicillins resistant to penicillinase or cephalosporin drugs, since they are active against the most common causative agents of lymphadenitis - Staphylococcus aureus and group A streptococci. Less often, lymphadenitis is caused by anaerobic bacteria living in the oral cavity, or even less often - by the bacterium Haemophilus influenzae type B.

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Antibiotics for lymphadenitis behind the ear

Inflammation of the nodes located behind the ear is called parotid lymphadenitis. Treatment of such pathology is based on eliminating its original cause. For example, antiviral agents are used for rubella or mumps, and antibiotics are prescribed for inflammatory processes in the inner ear, in the auditory canal, as well as for idiopathic lymphadenitis.

It is optimal to use drugs with a wide spectrum of antibacterial activity - for example, it is appropriate to use semi-synthetic penicillins, macrolides, β-lactam antibiotics, representatives of the cephalosporin series. Indicators of a successful choice of drug are symptoms such as a decrease in the volume of the lymph node, pain relief, and stabilization of temperature indicators.

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Antibiotics for inguinal lymphadenitis

Inguinal lymphadenitis can develop after the pathogen penetrates 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 most common underlying causes are:

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

The treatment regimen depends on many individual characteristics of the disease. The following may be prescribed as standard:

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

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

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Antibiotics for axillary lymphadenitis

In case of axillary lymphadenitis, antibiotics and immune support agents are usually prescribed. Among the most popular antibiotics are:

• Azithromycin is a 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 derived from the mold penicillium. The drug can be administered intravenously or intramuscularly. The course of treatment lasts 7-10 days (or longer, as determined by the doctor).
• Vilprafen (Josamycin) is a representative of the macrolide group. The recommended dose of the antibiotic for an adult patient is 1-2 g in 2-3 doses. The duration of treatment is at least 10 days.
• Amoxicillin is a semi-synthetic antibiotic with 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.
• Suprax (Cefixime) is a series of third-generation semi-synthetic cephalosporin antibiotics. The drug is intended for oral administration and has a bactericidal effect. The average daily dose for adults is 400 mg. The duration of the treatment course is about 10 days.

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Antibiotics for lymphadenitis in children

Just as in adulthood, when prescribing an antibiotic for lymphadenitis in children, you should first find out the characteristics of the disease: clarify the cause, degree and stage of development of the inflammatory process. One condition must be strictly followed: there should be no independent use of antibiotics - especially in childhood.

It is impossible to cure lymphadenitis in a child with antibiotics alone, since it is necessary to act on the problem in a complex manner. The usual treatment regimen always consists of an antipyretic and anti-inflammatory drug, an immunomodulator, and a multivitamin. If acute purulent lymphadenitis occurs, then surgical intervention in the form of opening or removing the inflamed node may be prescribed.

If surgery is not required, then most young patients are prescribed broad-spectrum antibiotics such as Suprax, Flemoxin Solutab, Augmentin - these drugs can be purchased both in tablet form and in the form of a sweet syrup or suspension.

After surgical opening of the purulent focus, a slightly different complex treatment is prescribed:

• antibiotic therapy using Azithromycin, Cefotaxime;
• taking antihistamines (for example, Fenistil);
• taking nonsteroidal anti-inflammatory drugs (eg, Ibuprofen);
• taking vitamin complex preparations for children.

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

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Use antibiotics for lymphadenitis. during pregnancy

During pregnancy, the risk of developing lymphadenitis is no less than under other circumstances, and even greater: after all, the immune defense is significantly weakened during this period. However, in the overwhelming majority of women, lymphadenitis becomes a complication of acute infectious diseases.

Despite the mass of precautions and prohibitions during pregnancy, lymphadenitis of bacterial origin is treated only with antibiotics. For women in such a situation, one of the most suitable and safe medications is chosen, taking into account the condition and sensitivity of the microbes.

The following antibiotics are preferably prescribed:

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

Of course, additional treatment is prescribed to enhance effectiveness:

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

In no case should you practice self-medication: if a pregnant woman follows all doctor's orders, then lymphadenitis will be cured quickly, without unpleasant consequences for the mother herself and her future child.

Contraindications

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

Semi-synthetic antibiotics may be contraindicated in the following diseases:

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

In elderly patients, if reduced renal function and metabolic activity are diagnosed, the dose of antibiotics may require adjustment.

If the liver and/or kidneys are not functioning properly, accumulation of drugs may occur, which is taken into account by the doctor.

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Side effects antibiotics for lymphadenitis.

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

• Allergic processes that manifest as urticaria, redness, swelling (including Quincke's edema), runny nose, conjunctivitis. Less common are fever, joint pain, eosinophilia, and the most serious complication, anaphylactic shock.
• Formation of superinfection during systemic treatment: fungal infections of the oral cavity, vagina, intestinal dysbacteriosis.
• Digestive disorders: vomiting, nausea, diarrhea.
• Nervous system disorders: increased reflex excitability, signs of meningism, convulsive states, coma. Neurotoxic manifestations may develop when benzylpenicillin is administered in large doses.
• Blood clotting disorder (bleeding syndrome).
• Water-electrolyte disturbances in the form of hyponatremia, hypokalemia. Such symptoms often develop when taking antibiotics in excessively high doses.
• Disorders of the urinary system – the appearance of hematuria, proteinuria, development of interstitial nephritis.
• Cholestatic jaundice – may be observed with the combined use of penicillins with clavulanic acid preparations (for example, Amoxiclav).
• Burning and redness of the skin - when an antibiotic is injected.

Why did the condition with lymphadenitis worsen after taking antibiotics?

Antibiotics used for lymphadenitis have a generally strong effect on the human body. Against the background of antibiotic therapy, many patients complain of a feeling of weakness, headaches, and a state of malaise. Such symptoms may appear for several reasons:

• the patient's immunity weakens - both because of the disease and because antibiotics destroy not only pathogenic but also beneficial flora in the body;
• When microbial cells are destroyed, endotoxins accumulate in the blood: such a reaction can be accompanied by fever and a general deterioration in health.

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

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Overdose

• Overdose of penicillin antibiotics and cephalosporins is manifested by nausea with vomiting and diarrhea. With intravascular administration of an excessive dose of penicillin, a convulsive state may develop. If the patient suffers from renal failure, then after the administration of penicillin, hyperkalemia often develops, the signs of which are visible on the ECG. Large doses are also fraught with encephalopathy, mental disorders.
• Overdose of tetracyclines causes abdominal pain with nausea. After using expired antibiotics, hypouricemia and hypokalemia may develop.
• In case of Levomycetin overdose, nausea with vomiting appears, appetite disappears, signs of respiratory failure are observed. Less often, acute signs of cardiac failure are detected within 5-12 hours after taking a large dose of the antibiotic.
• Overdosage of fluoroquinolone antibiotics causes cardiac and/or renal failure, toxic liver damage, and joint pain.

Treatment of overdose begins with complete withdrawal of the drug and acceleration of its elimination from the body. Osmotic diuretics and activated carbon become indispensable in this situation. If necessary, symptomatic treatment is prescribed.

The occurrence of seizures is a reason for prescribing diazepam, and in case of severe renal failure, hemodialysis or other methods for blood purification may be used.

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Interactions with other drugs

The most commonly used antibiotics for lymphadenitis – penicillins – cannot be prescribed in combination with allopurinol due to the high risk of developing “ampicillin rash”.

Antibacterial synergism is observed when penicillins are used with macrolides or tetracyclines. Aminoglycosides are combined with penicillins only when taken orally: mixing these antibiotics in one syringe leads to a loss of activity of the drugs.

Before prescribing antibiotics to women of childbearing age, it is necessary to clarify whether they are taking oral contraceptives, since some drugs, such as penicillins, can interfere with their effectiveness. During antibiotic treatment, women should temporarily stop taking contraceptive pills, replacing them with barrier methods of contraception.

Penicillins are avoided in patients who are taking anticoagulants, antiplatelet agents, and nonsteroidal anti-inflammatory drugs at the same time due to the high risk of bleeding.

Macrolides are not used in combination with antacids (the effectiveness of antibiotic therapy decreases). Also, macrolide antibiotics are not recommended together with amphenicol and lincosamides, statins.

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Storage conditions

Most antibiotics used for lymphadenitis are designed to be stored at normal room temperature - that is, the optimal values will be +15-22°C. Sometimes the instructions indicate special conditions for preserving the drugs - for example, a dry cool place (refrigerator) may be recommended for injection solutions.

Antibacterial tablets and capsules are usually stored indoors, in dark places, away from heating devices.

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

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Shelf life

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

The expiration date indicated on the medicine packaging can only be true if the adequate temperature conditions specified in the annotation to the medicine were observed.

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

Lymphadenitis can be of bacterial, viral, allergic origin. Such origin is determined by preliminary tests – for example, a smear for flora and sensitivity to antibiotics.

The viral type is not treatable with antibiotics - there are antiviral drugs for this. In case of allergic lymphadenitis, antibiotics will not bring any benefit either - moreover, they can harm. In such situations, there will be no positive dynamics in the treatment of lymphadenitis, since the drugs 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 such a situation, you need to take the previously mentioned analysis of flora and sensitivity to antibiotics.

Is it possible to cure lymphadenitis without antibiotics?

Antibiotics are not always appropriate for lymphadenitis. We have already mentioned that the disease may be viral or allergic in nature, and antibacterial agents are not prescribed in such situations.

The cause of enlarged lymph nodes plays a fundamental role in determining the need for antibiotic therapy: it is determined by examining the area from which lymph flows into the affected nodes, as well as by laboratory tests (complete blood count, infectious mononucleosis test, antistreptolysin titers, VDRL reaction, etc.). The most common diagnostic method is a puncture with a biopsy of the node. The removed material is subjected to Gram staining, sown on a nutrient medium to determine the cultures of aerobic and anaerobic microorganisms, as well as mycobacteria.

In lymphadenitis caused by atypical mycobacteria, antibiotics are not needed in most cases: if the disease worsens, 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 even before receiving the results of the culture and bacterioscopy if the situation requires urgent treatment. In such a situation, penicillin drugs or other antibiotics active against the most common pathogens are used.