Ludwig's Angina

For deep neck space infection (Click here)

Case Definition:

Ludwig’s angina is a bacterial submandibular and sublingual indurated cellulitis without abcess formation. Infections begins in the floor of the mouth and causes brawny submandibular swelling that may cause airway obstruction.

Diagnostic criteria:

Submandibular, brawny, indurated cellulitis. Tongue may be pushed towards the roof of the mouth due to mouth floor swelling. Eating and swallowing may be difficult and breathing difficulty indicates airway compromise. Fever is usually present.

 

Severity
(classification)

1st line oral/iv antibiotics

Penicillin allergy
(see explanatory notes)
A/B/C

Minor to severe life threatening infection 

Review doses in renal impairment

BENZYLPENICILLIN 1.2g iv qds

(NB. increase to 2.4g iv qds if severe systemic toxicity)

Plus

METRONIDAZOLE 400mg po tds

If current/previous MRSA positive:

Add

TEICOPLANIN iv every 12 hours for 4 doses then once daily.

Dose

<50kg: 400mg

50-100kg: 600mg

>100kg: 800mg 

Maintain treatment pending pre-dose (trough) level on Day 5. Target level 15-60mg/L.

Typical total duration: 7-10 days

CLINDAMYCIN 1.2g iv qds

If current/previous MRSA positive:

Add

TEICOPLANIN iv every 12 hours for 4 doses then once daily.

Dose

<50kg: 400mg

50-100kg: 600mg

>100kg: 800mg 

Maintain treatment pending pre-dose (trough) level on Day 5. Target level 15-60mg/L.

 

 

 


Typical total duration: 7-10 days

 IV to Oral Switch (explanatory notes)

 

AMOXICILLIN 500mg po qds

Plus

METRONIDAZOLE 400mg po tds

If current/previous MRSA positive:

Add

DOXYCYCLINE 200mg po od

Typical total duration: 7-10 days

 CLINDAMYCIN 450mg po qds

If current/previous MRSA positive:

Add

DOXYCYCLINE 200mg po od

 

 

Typical total duration: 7-10 days

Last reviewed: 23/04/14

For guidance on the administration of intravenous antibiotics
click here (GHNHSFT intranet only)