Earlier this month I saw a patient who was
referred to me by his General Practitioner with phlebitis. His GP had been treating him
with antibiotics and if anything, his leg was getting worse. Now treating phlebitis
with antibiotics is simply wrong and I am going to tell you the truth about phlebitis.
Phlebitis is simply a medical term indicating that there is inflammation in the vein. Most
commonly it affects the superficial leg veins and it is associated with localised swelling
— a lump- which is red, tender and warm and sometimes the lump actually feels hot and
painful. Usually phlebitis comes on out of the blue for no apparent reason but very occasionally
I see phlebitis as a complication of some cancers, intravenous arm catheters used in
hospital — drips – or sometimes as a reaction to some very irritant intravenous injections
such as chemotherapy. I haven’t seen a case of phlebitis due to bacteria for years and
that happened in a drug addict who was injecting into a leg vein with dirty needles. The standard
usual case of superficial leg vein phlebitis seen by a GP does not need antibiotics. Antibiotics
may do more harm than good. Now until recently, phlebitis in superficial leg veins was thought
to be a rather trivial condition and many doctors dismissed phlebitis as being of no
real significance. Even the term phlebitis is often misunderstood and misused. Many people
including doctors describe any discomfort in their veins as being phlebitis. To absolutely
sure that the problem is phlebitis, a duplex ultrasound scan is needed — the ultrasound
appearance of phlebitis is characteristic and diagnostic. The vein wall is thickened
and there is a variable amount of clot inside the vein. A scan is the only way of checking
the vein directly and confirming that the vein is inflamed. Ultrasound has also revealed
that a very important group of people with phlebitis either already have a DVT or they
are at risk of developing a deep vein thrombosis. The inflammation in the wall of the veins
affected by phlebitis activates clotting of the blood inside these veins. This clot can
extend or spread from the superficial vein into the deep vein. So this is another very
important reason why everyone with phlebitis should have a duplex ultrasound scan. A duplex
scan is the only way to correctly identify people who already have a DVT and who need
treatment to prevent that clot leaving the leg, travelling around the body and lodging
in the lung — a serious condition -sometimes fatal- called a pulmonary embolism. A duplex
scan will also determine whether these people with phlebitis are at risk of a DVT and who
need preventative treatment. So the first important message is that everyone with phlebitis
should have a duplex ultrasound scan. So how should superficial leg vein phlebitis
be treated? Well we can only offer the correct treatment for phlebitis if we know the results
of the duplex scan. The scan may show that the phlebitis is only in a small area and
that only a limited number of superficial veins are affected. If there is very little
associated clot in these superficial veins and if this clot is well away from the deep
veins, then treatment with aspirin or aspirin-like medication called non –steroidal inflammatory
drugs and compression stockings may be sufficient. A good medical sock will support the vein
while it is recovering and the anti-inflammatory tablets or cream will ease the swelling and
pain. If the phlebitis is extensive or if the clot in the superficial veins is already
close to the deep veins, a course of blood thinning injections — anticoagulant heparin
medication- is needed to reduce the significant risk of developing a DVT. Of course if the
scan shows that a DVT has already formed, full anticoagulant treatment for several months
is needed. So the correct treatment of phlebitis requires a scan.
So in summary, phlebitis is not an infection and antibiotics are not the correct treatment.
Phlebitis is not a trivial condition, it can be serious and may cause a Deep Vein Thrombosis.
Everyone with phlebitis should have a duplex ultrasound scan to confirm the correct diagnosis,
to check for DVT and to guide the correct treatment.
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