# Acute lymphadenitis - Category: acute - Review status: reviewed (every claim checked against a document named on this page) - 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 date: 2026-08 ## Verified against - 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. ## Treatment metadata - Cephalexin — oral.solid - Clindamycin — oral.solid ## Complete treatment card ```text ACUTE LYMPHADENITIS 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. Review status: REVIEWED against 2 sources listed above (2026-08) 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 Source StatPearls "Lymphadenopathy" - disease-level clinical article Status traced to the source above 1. CEPHALEXIN [1st line] Adult 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) Peds 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). 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. Caution 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. Egypt AMTHROST 250 MG 10 F.C. TAB. SIGMA > SABAA 4.00 EGP (0.40/unit) CEPHALEXIN 250MG 12CAPS. B.P.2000 ARAB DRUG COMPANY (ADCO) 5.28 EGP (0.44/unit) CEPHALEXCID 250MG 12CAPS. CID 6.43 EGP (0.54/unit) STARCEF 500MG 20 CAP. SIGMA 18.00 EGP (0.90/unit) STARCEF 1GM 12 F.C. TAB. SIGMA 20.40 EGP (1.70/unit) OSPEXIN 1000 MG 12 TABS. EL NILE. > NO... 28.80 EGP (2.40/unit) CEPOREX 1 GM 8 TABLETS GLAXO SMITHKLINE 78.00 EGP (9.75/unit) CEPOREX 250 MG/5ML SYRUP 60 ML GLAXO SMITHKLINE 23.50 EGP AMTHROST 125MG/5ML SUSP. 60ML SIGMA > SABAA 4.00 EGP -> ? strength differs, ? different route - not oral solid AMTHROST 250MG/5ML SUSP. 60ML SIGMA > SABAA 4.50 EGP -> ? strength differs, ? different route - not oral solid 2. CLINDAMYCIN [2nd line] Adult Oral: 150–300 mg every 6 hours. - As directed Peds 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. 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. Caution 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. Egypt ADCOCLINDACE 150 MG 16 CAPS. ARAB DRUG COM... 14.50 EGP (0.91/unit) ALFACLINDAMYCIN 150 MG 10 CAPS. ATCO PHARMA >... 14.50 EGP (1.45/unit) ADCOCLINDACE 300 MG 16 CAPS. ARAB DRUG COM... 24.00 EGP (1.50/unit) CLINACYN 300MG 16 CAPS. SIGMA > EGYPT... 31.50 EGP (1.97/unit) MEPACLIND 150MG 16 CAPS. MEPACO 48.00 EGP (3.00/unit) MEPACLIND 300MG 8 CAPS. MEPACO 38.00 EGP (4.75/unit) ALFACLINDAMYCIN 300 MG 10 CAPS. ATCO PHARMA >... 69.00 EGP (6.90/unit) DALACIN C 300MG 10 CAPS. PFIZER 114.00 EGP (11.40/unit) KLENDABIOTICAM 1 % TOP. SOLUTION PANAX PHARMA 8.50 EGP -> ? strength differs, ? different route - not oral solid ADCOCLINDACE 10MG/ML TOP. SOL. ARAB DRUG COM... 12.00 EGP -> ? strength differs, ? different route - not oral solid Prices are indicative (dataset snapshot 2026-06); verify with the pharmacy. ``` --- Dawaa Reference is a reference for prescribers, not a medical device, and does not replace clinical judgement. [Privacy policy](/privacy)