Lemierre's Syndrome: What are the Roles for Anticoagulation and Long-Term Antibiotic Therapy?

Objectives: We wanted to describe what Lemierre's syndrome is and what risk factors may be involved, and to understand the roles, if any, of antibiotics and anticoagulants in the treatment of this syndrome. Methods: We performed a review of the pertinent literature regarding Lemierre's syndrome, as well as a review of otology, obstetrics and gynecology, and internal medicine literature looking at both anticoagulation and long-term antibiotic treatment for septic thrombosis. Results: The vast majority of patients with Lemierre's syndrome are successfully treated nonsurgically with antibiotics and, often, anticoagulation as well. Surgical intervention is reserved for those cases with persistent showering of septic emboli or continued propagation of the thrombosis. Although anticoagulation is commonly used in other specialties for similar septic thromboses, its role in Lemierre's syndrome is unclear at the present. Conclusions: Because Lemierre's syndrome is so rare, it is difficult to ascertain absolutely the need for either anticoagulation or long-term antibiotic therapy. At this time, the risks and benefits of providing either therapy must be weighed against the potential complications of incompletely treating septic thrombosis.