Q: Which of the following antibiotics is suitable for Internal Jugular (IJ) Central venous catheter (CVC) related suppurative thrombophlebitis?

A)  ampicillin-sulbactam 
B) piperacillin-tazobactam 
C) ticarcillin-clavulanate 
D) Addition of Vancomycin to any of the above antibiotics


Answer: D 

Jugular vein suppurative thrombophlebitis is popularly known as Lemierre's syndrome, postanginal sepsis, and necrobacillosis. Jugular vein suppurative thrombophlebitis is a life threatening infection. First and most importantly, foci of infection i.e. CVC should be removed. All of the antibiotics outlined in choices A, B and C are appropriate choices. But, in ICU or hospital setting vancomycin should be added to cover against skin flora.

Objective of above question is to emphasis the point that empiric therapy for jugular vein suppurative thrombophlebitis should include a beta-lactamase resistant beta-lactam antibiotic, along with vancomycin in hospital (or ICU) setting. Moreover, "lines" should be discontinued ASAP, if they are not needed. "Lines" should not be left for "just in case" reasons!


Reference:

Hagelskjaer Kristensen L, Prag J. Lemierre's syndrome and other disseminated Fusobacterium necrophorum infections in Denmark: a prospective epidemiological and clinical survey. Eur J Clin Microbiol Infect Dis 2008; 27:779.