Lymphovenous Canada: Antibiotic use in preventing infection

People with lymphedema are vulnerable to infection and often get skin breakdown. Infections are most often caused by streptococci and staphylococci bacteria. With each acute situation of infection, tissue becomes damaged and the swelling becomes more serious. Individuals with repeated infections cannot hold down jobs or participate in society in a meaningful way. Small daily doses of antibiotics over an extended period of time - from several months to in some cases a number of years - has been found helpful in reducing the incidence of infections in these individuals.

Some health care providers have expressed reluctance to utilize this form of treatment out of fear that they may be facilitating antibiotic resistance. Despite concerns about bacteria resistance, however, prophylactic use of antibiotics in adults with lymphedema who have acute and repeated infections is still a helpful form of treatment.

Penicillin was discovered in 1929. Mass production and distribution of this drug took place during World War II in the 1940's. Research since that time has found the use of penicillin effective in preventing repeated infections. Historically Penicillin V has been most often been the drug of preference where individuals with lymphedema have acute and repeated cases of infection. Recently, other antibiotics with anti-inflammatory properties have also been suggested in the treatment of infections in people with lymphedema. (see interview with Dr. Sibbald at: sibbald.htm) These include: tetracycline, trimethoprin, clindamycin, erythromycins (Note to consumers: erythromycin has been linked to heart attacks when it reacts with the two heart medications: diltiazem and verapamil; FDA July 10, 2008 warning on the increased risk of tendinitis and tendon rupture when using fluroquinolones such as Cipro, Factive, Levaquin, Avelox, Noroxin, Floxin and genetic ofloxacin).

Some breast cancer survivor groups have recommended the use of prophylactic (preventive) antibiotics before dental procedures if there is already significant arm edema. They suggest that a dental procedure may trigger an arm infection, noting that people with heart valve disease take prophylactic antibiotics before or right after a dental procedure for the same reason.

Dr. Peter Mortimer, a dermatologist and internist who specializes in treating lymphedema in Britain, has been using daily doses of oral 500 mg of penicillin V on many of his adult and child patients who have had repeated infections, with great success. He disputes suggestions that long-term use of small doses of this particular antibiotic causes bacteria resistance. (For more information on Dr. Mortimer's prophylactic use of antibiotics you can contact him at: pmortimer@sghms.ac.uk)

Dr. W. Olszewski, a medical doctor with expertise on lymphatic disorders in Poland, has applied injections of long-acting penicillin (benzathine penicillin) intramuscularly over a period of years, and recommends the prophylactic use of antibiotics, while other medical specialists have recommended the use of oral penicillin V or other antibiotics for extended periods of time.

At the XIX International Congress of Lymphology in Sept. 2003 Dr. Olszewski presented his findings on the effectiveness of long-lasting penicillin in controlling skin, deep tissues and tissue fluid bacterial flora, and the prevention of recurrences of dermatollymphangioadentis (DLA) in patients with filarial lymphedema. 74 randomly selected patients from Tanajavur, Chennai and Varanasi were treated prophylactically with benzthine penicillin (penidur). All patients experienced 1-3 episodes of infection per year. 40 patients received 1200,000 to 2400,000 units of penidur at 2-4 week intervals for 12 months; 34 patients received no penidur - but did receive antibiotics when they experienced infection. Dr. Olszewksi found a statistically significant difference between the two groups with a decrease of penidur in the treated patients.

Consumer Jeff Dorton's story Is Amputation Necessary? How Lymphedema Changed My Life Vol. 1, Issue 4, Spring/Summer 2002 www.eLymphNotes.org is a sober wake-up call to health care professionals who do not prescribe antibiotics when they are necessary. We meet up with Jeff, once a active outdoors man, bedridden and talking about the potential amputation he faces to both his legs due to repeated inadequately treated infections. He ends his story by urging people with lymphedema to fight for antibiotics if there is any indication of infection.

Why are some people more susceptible to infections than others? UBC researcher Professor Wilfred Jefferies has discovered the mechanism which regulates immune response. In the November 2003 issue of Nature Immunology Professor Jefferies talks about this mechanism which appears to act like a dial on our immunity system. Jefferies believes it will take about five years for scientists to use this information to create new therapies - such as medication or vaccines - to regulate immune responses in humans. (Information from: UBC Media October 22, 2003 media release "UBC Researcher Discovers "Control Room" that Regulates Immune Responses".

• ABC of arterial and venous disease swollen lower limb – 2: Lymphoedema. British Medical Journal 2000; 320: 1527-1529 (3 June) Peter Mortimer.
• Consensus document on the management of cellulitis in lymphoedema. British Lymphology Society. February 2007. http://www.lymphoedema.org/lsn/consensus_on_cellulitis_dec_06.pdf
• Episodic dermatolymphangioadentis (DLA) in patients with lymphedema of the lower extremities before and after the administration of benzathine penicillin: a preliminary study, Lymphology, 1996 Sept; 29(3):126-31. Olszewski, WL.
• How to Avoid Lymphedema http://www.Breastcancer.org March 25, 2003 (infection in an affected arm after dental surgery).
• Is Amputation Necessary? How Lymphedema Changed My Life.www.eLymphNotes.org: Vol. 1, Issue 4, Spring/Summer 2002. Jeff Dorton.
• Oral erythromycin and the risk of sudden death from cardiac causes. New England Journal of Medicine, Vob. 351:1089-1096, Sept. 9, 2004 No. 11. Wayne A. Ray, Ph.D., Katherine T. Murray, M.D., Sarah Meredith, M.B., B.S., Sukumar Suguna Narasimhulu, M.B., B.S., M.P.H., Kathi Hall, M.S., and C. Michael Stein, M.B., Ch.B.
• Prophylactic antibiotics in Children. Infectious Diseases and Immunization Committee, Paediatrics and Child Health 1999; 4(7): 490 - 494. Canadian Paediatric Society.
• Prophylactic use of antimicrobial agents in adult patients. Mayo Clinical Proc. 1992 March; 67(3): 288-92. Van Scoy RE, Wilkowske CJ.
• Prophylaxis of recurrent lymphangitis complicating lymphedema. JAMA. 1966 Mar 7;195(10):871-3. Babb RR, Spittell JA Jr, Martin WJ, Schirger A.
• Recurrent erysipelas caused by group B streptococcus organisms. Arch Dermatol. 1980 Jul;116(7):798-9. Binnick AN, Klein, Baughman RD.