In combination with the conventional combined therapies used for the treatment of lymphedema, antibiotic prophylaxis often represents the only means of preventing lymphangitis. Individuals with lymphedema have an immunodeficiency in the anatomical regions affected by lymphatic stasis, which is not related to a cellular deficit as seen in other pathological conditions of systemic immunodeficiency. Instead, it is linked to a “difficulty” in the movement of immune system cells, particularly Antigen Presenting Cells (APC).

This results in a slowdown of normal cell-mediated defense processes. As a result, patients are exposed to potential frequent infectious episodes, which are highly concerning due to the acuteness of the condition and the subsequent clinical worsening of lymphatic insufficiency that may occur. This is why antibiotic prophylaxis with “delayed penicillins” is often recommended for patients with lymphatic stasis. Examples of these antibiotics include benzathine penicillin and procaine penicillin, which are administered intramuscularly at intervals of 15-21 days, sometimes for extended periods of time. 

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