Infectious Disease Compendium

Ludwig's Angina

Diagnosis

Infections in the sublingual, submaxillary, or submandibular spaces.

Epidemiologic Risks

Poor dentition.

Microbiology

Viridans and other streptococci, Peptostreptococcus spp., Bacteroides spp., and oral anaerobes.

Empiric Therapy

Penicillin G OR ampicillin PLUS metronidazole OR penicillin/beta-lactamase inhibitors OR clindamycin OR cefoxitin OR cefotetan.

Pearls

Like all collections of pus, drain it. These are quasi-emergencies and the big risk is airway obstruction. Put a trach kit in the room as a magical talisman; once in the room they are never needed.

Rants

Given the increased resistance of streptococci and anaerobes to clindamycin (maybe 30%), I no longer use it.

ICD9 Codes (Soon to be supplanted by ICD10)

Ludwig's 528.3.