Jugular Vein Septic Phlebitis (Lemierre's Syndrome)

- Suspect in teenagers/young adults with pharyngitis/fever and neck pain/swelling.

- May occur as a rare complication of otitis media, tonsillitis, or dental infections.

 
Usual Pathogens

Fusobacterium necrophorum

 
Polymicrobial (1/3):

Oral anaerobes
Streptococcus spp

 

Empiric Therapy Dose Duration
Surgical drainage as appropriate    
+    
Penicillin 3-4MU IV q4h 6-12 weeks
+    
Metronidazole 500mg IV q8h  

Penicillin allergy

Empiric Therapy Dose Duration
Clindamycin 600mg IV q8h 6-12 weeks
+    
Metronidazole 500mg IV q8h