Dawaa Reference

acute

Acute lymphadenitis

Treatment options, dosing, cautions and Egyptian brands from the shipped Dawaa Reference card.

Evidence status

Checked against the sources named below

Sources3 sources

Egyptian National Drug Formulary - antimicrobial-2023.pdf, Cephalexin monograph (chapter PDF p220) · Egyptian National Drug Formulary - antimicrobial-2023.pdf, Clindamycin monograph (chapter PDF p287) · Long M, Reddy DN, Akiki S, Barrowman NJ, Zemek R. Paediatric acute lymphadenitis: Emergency department management and clinical course. Paediatrics & Child Health. 2019 Sep 21;25(8):534-542. doi: 10.1093/pch/pxz125. PMCID: PMC7739529, PMID: 33354264.

Verified against3 documents
  • Egyptian National Drug Formulary - antimicrobial-2023.pdf, Cephalexin monograph (chapter PDF p220)
  • Egyptian National Drug Formulary - antimicrobial-2023.pdf, Clindamycin monograph (chapter PDF p287)
  • Long M, Reddy DN, Akiki S, Barrowman NJ, Zemek R. Paediatric acute lymphadenitis: Emergency department management and clinical course. Paediatrics & Child Health. 2019 Sep 21;25(8):534-542. doi: 10.1093/pch/pxz125. PMCID: PMC7739529, PMID: 33354264.

Verified date2026-08

Presentation reference

Is it this?

Reference only, to read alongside your own examination.

Symptoms — what the patient reports (3)

  • Fever, chills, sweats at night, loss of weight and tiredness raise concern when nodes are up in several areas [chills · fatigue · fever]
  • Nodes still up beyond 3 weeks meet the definition of chronic
  • Ask about diet, pets, insect bites, sexual and injecting risk, animal contact at work, and travel

Signs — what you find (8)

  • Enlarged nodes in 2 or more separate, non-touching regions counts as generalised [lymphadenopathy]
  • Firm rubbery nodes point towards lymphoma, softer ones towards infection, stony hard ones towards cancer
  • A painful node may reflect inflammation, or bleeding into the dead centre of a cancerous node [bleeding]
  • Whether a node hurts does not dependably separate cancerous from benign ones
  • Tiny scattered neck nodes like pellets under the skin are usual in children with viral illness
  • Clustered nodes that seem fused to each other point towards cancer without proving it
  • A node above the right clavicle drains the chest cavity, lung and gullet
  • Groin nodes drain the genitals, perineum, buttock, lower belly wall and part of the anal canal

Tests (9)

  • A full blood count with manual differential can point to a bacterial, viral or fungal cause
  • Serology worth sending: EBV, CMV, HIV, Bartonella henselae, syphilis, herpes simplex, toxoplasma, hepatitis B and ANA
  • When first-line testing is negative, next comes PPD, RPR, chest film, ANA, hepatitis B surface antigen and HIV
  • A chest film may reveal tuberculosis, sarcoid in the lung, or a lung tumour
  • Ultrasound gauges how many nodes, their size, shape, margin definition and inner structure
  • Colour Doppler tells long-standing nodes from newly active ones by their vessel pattern
  • Ultrasound ratio of long axis to short axis, when low, points to lymphoma or cancer spread
  • Where cancer or serious illness is a risk, take a biopsy rather than watch
  • If testing leaves things unclear, sample whichever node looks most abnormal

If not this — what else fits (10)

  • Widespread nodes from infection: glandular fever, HIV, TB, typhoid, syphilis, plague
  • Cancers behind widespread nodes: acute leukaemia, Hodgkin and non-Hodgkin lymphoma
  • Drugs enlarge nodes - allopurinol, atenolol, captopril, carbamazepine, cephalosporins, phenytoin, penicillin among them
  • Autoimmune causes: Sjogren syndrome, sarcoid, rheumatoid arthritis, lupus
  • Storage disorders behind widespread nodes: Gaucher and Niemann-Pick disease
  • Viral neck-node causes: upper respiratory infection, glandular fever, herpes, coxsackie, CMV, HIV
  • Bacterial neck-node causes: Staph aureus, group A strep, mycobacteria, dental abscess, cat scratch disease
  • Armpit nodes: staph, cat scratch, brucellosis, lymphoma, breast cancer, melanoma, breast implant reaction
  • Groin nodes: sexually transmitted infection, cellulitis, lymphoma, genital squamous carcinoma, melanoma
  • Outside the industrialised world, TB is a leading cause of both regional and widespread node enlargement

SourceStatPearls "Lymphadenopathy" - disease-level clinical article

Presentation findings are traced to the source above.

1

CEPHALEXIN

1st line

Formoral.solid

Adult dose and duration

250 to 1,000 mg every 6 hours, or 500 mg every 12 hours (maximum 4 g/day) - As directed (typically 7-10 days for a straightforward skin/lymph node infection)

Paediatric dose

Mild-to-moderate infection: 25 to 50 mg/kg/day divided every 6 or 12 hours, maximum 2,000 mg/day (a higher weight-based dose is given in the formulary for severe bone/joint infection, not usually needed for straightforward lymphadenitis).

Dose source

Egyptian National Drug Formulary - antimicrobial-2023.pdf, Cephalexin monograph (chapter PDF p220)

Why

First-generation oral cephalosporin covering the Staphylococcus aureus and Streptococcus species that most often cause acute bacterial lymphadenitis; reasonable first oral choice in a Cairo GP setting.

Cautions
  • Ask about penicillin allergy - cross-reactivity with cephalosporins is possible, especially with a history of a severe/anaphylactic penicillin reaction.
  • Reduce the dose in significant renal impairment.
  • If the node becomes fluctuant/abscessed, antibiotics alone will not resolve it - refer for incision and drainage.
  • If the node is fixed, hard, and non-tender, or there is weight loss/night sweats or generalized lymphadenopathy, treat for infection but also investigate for malignancy or TB lymphadenitis rather than assuming a simple bacterial cause.
  • Refer urgently for rapidly spreading redness or signs of systemic sepsis. TB lymphadenitis is common in Egypt - consider it for a persistent node with weight loss or night sweats.
Egyptian brands
Egyptian brandManufacturerIndicative price
AMTHROST 250 MG 10 F.C. TAB.SIGMA > SABAA4.00 EGP (0.40/unit)
CEPHALEXIN 250MG 12CAPS. B.P.2000ARAB DRUG COMPANY (ADCO)5.28 EGP (0.44/unit)
CEPHALEXCID 250MG 12CAPS.CID6.43 EGP (0.54/unit)
STARCEF 500MG 20 CAP.SIGMA18.00 EGP (0.90/unit)
STARCEF 1GM 12 F.C. TAB.SIGMA20.40 EGP (1.70/unit)
OSPEXIN 1000 MG 12 TABS.EL NILE. > NOVARTIS28.80 EGP (2.40/unit)
CEPOREX 1 GM 8 TABLETSGLAXO SMITHKLINE78.00 EGP (9.75/unit)
CEPOREX 250 MG/5ML SYRUP 60 MLGLAXO SMITHKLINE23.50 EGP
AMTHROST 125MG/5ML SUSP. 60ML? strength differs? different route - not oral solidSIGMA > SABAA4.00 EGP
AMTHROST 250MG/5ML SUSP. 60ML? strength differs? different route - not oral solidSIGMA > SABAA4.50 EGP
2

CLINDAMYCIN

2nd line

Formoral.solid

Adult dose and duration

Oral: 150–300 mg every 6 hours. - As directed

Paediatric dose

Oral: 8 to 20 mg/kg/day (hydrochloride capsule) or 8 to 25 mg/kg/day (palmitate solution) divided every 6 to 8 hours - general susceptible-infection dosing, not lymphadenitis-specific in this excerpt.

Dose source

Egyptian National Drug Formulary - antimicrobial-2023.pdf, Clindamycin monograph (chapter PDF p287)

Why

Alternative when there is penicillin/cephalosporin allergy or better anaerobic/skin-flora coverage is wanted; not first choice over cephalexin for straightforward lymphadenitis.

Cautions
  • Risk of Clostridioides difficile-associated diarrhoea, which can occur weeks after stopping the drug - stop the drug and seek review for new, severe, or bloody diarrhoea.
  • Use as an alternative when there is penicillin/cephalosporin allergy or concern for resistant/anaerobic organisms, not as a routine first choice over cephalexin.
  • Caution in hepatic impairment.
  • Same red flags as above - refer urgently if the node is fluctuant, spreading rapidly with signs of sepsis, or suspicious for malignancy/TB.
Egyptian brands
Egyptian brandManufacturerIndicative price
ADCOCLINDACE 150 MG 16 CAPS.ARAB DRUG COMPANY (ADCO)14.50 EGP (0.91/unit)
ALFACLINDAMYCIN 150 MG 10 CAPS.ATCO PHARMA > ROTABIOGEN14.50 EGP (1.45/unit)
ADCOCLINDACE 300 MG 16 CAPS.ARAB DRUG COMPANY (ADCO)24.00 EGP (1.50/unit)
CLINACYN 300MG 16 CAPS.SIGMA > EGYPTIAN PHARMACISTS COMPANY31.50 EGP (1.97/unit)
MEPACLIND 150MG 16 CAPS.MEPACO48.00 EGP (3.00/unit)
MEPACLIND 300MG 8 CAPS.MEPACO38.00 EGP (4.75/unit)
ALFACLINDAMYCIN 300 MG 10 CAPS.ATCO PHARMA > ROTABIOGEN69.00 EGP (6.90/unit)
DALACIN C 300MG 10 CAPS.PFIZER114.00 EGP (11.40/unit)
KLENDABIOTICAM 1 % TOP. SOLUTION? strength differs? different route - not oral solidPANAX PHARMA8.50 EGP
ADCOCLINDACE 10MG/ML TOP. SOL.? strength differs? different route - not oral solidARAB DRUG COMPANY (ADCO)12.00 EGP

Prices are indicative (dataset snapshot 2026-06); verify with the pharmacy.