How to identify and manage life-threatening infections of the upper airway, Part 2: Intravenous antibiotics are the mainstay of treatment

Although uncommon, Lemierre syndrome and Ludwig angina are among the most serious of the life-threatening upper airway infections. The initial presentation of Lemierre syndrome usually is an oropharyngeal infection. After a latent period of 1 to 3 weeks, internal jugular vein (IJV) thrombosis occurs and sepsis develops - the diagnosis is based on this. Since IJV thrombosis usually is not readily apparent on physical examination, ultrasonography, CT, and MRI may be needed. Intravenous antibiotics, such as clindamycin, metronidazole, ticarcillin-clavulanate, and ampicillin-sulbactam, are first-line treatment. Ludwig angina is a potentially life-threatening cellulitis and necrotizing fasciitis of the submandibular space. It usually affects previously healthy patients who have had oral or odontogenic infection. The diagnosis is based on the history and physical examination. Treatment includes evaluation of the airway, use of intravenous antibiotics and, rarely, surgical drainage. High doses of penicillin are the mainstay of therapy.