eMedicine Specialties > Dermatology > Bacterial Infections

Arcanobacterium Haemolyticum: Treatment & Medication

Author: Kyle L Horner, MD, MS, Staff Physician, Department of Dermatology, Penn State Milton S Hershey Medical Center
Coauthor(s): Gregory J Raugi, MD, PhD, Professor, Department of Internal Medicine, Division of Dermatology, University of Washington at Seattle; Chief, Dermatology Section, Primary and Specialty Care Service, Veterans Administration Medical Center of Seattle; Kord Honda, MD, Fellow in Dermatopathology, Division of Dermatology, Department of Medicine, University of Cincinnati
Contributor Information and Disclosures

Updated: Sep 11, 2009

Treatment

Medical Care

Without antibiotic therapy, symptoms from Arcanobacterium haemolyticum pharyngeal infection last from a few days to 2 weeks. With antibiotic therapy, patients have symptoms for an average of 3 days.33 Whether antimicrobial therapy prevents late sequelae of infection is not known. However, the fact that the organism's prevalence may be increasing and because some of infections may be serious, antibiotic therapy is recommended.54

Surgical Care

Patients who develop a peritonsillar abscess require incision and drainage in addition to antibiotics.

Consultations

Consult an otolaryngologist to drain any suspected peritonsillar abscesses.

Diet

No specific dietary recommendations are indicated for this disease.

Activity

Patients can perform their normal activities.

Medication

No controlled trials of antimicrobial therapy have been conducted for pharyngitis caused by A haemolyticum. Many patients with pharyngitis have been treated with 1 dose of intramuscular penicillin or 7-10 days of erythromycin or oral penicillin.33 Antibiotic sensitivity testing reveals that most strains are resistant to trimethoprim-sulfamethoxazole; tetracycline resistance has been observed in 30% of strains tested.5,55 A recent isolate was also resistant to ciprofloxacin.28 Virtually all strains of A haemolyticum studied so far are sensitive to erythromycin, azithromycin, gentamicin, and clindamycin.5,56 The majority of isolates are susceptible to penicillin, although tolerance has been reported. Accordingly, macrolides are now considered the drugs of choice.33,34,35

Penicillin treatment failures also may be related to the ability of A haemolyticum to invade HEp-2 cells (immortalized upper respiratory epithelial cells) and survive there for 4 days, thus creating an intracellular reservoir of bacteria.36 Macrolides achieve much higher intracellular concentrations than penicillin.36,57,58

More serious systemic infections have been treated successfully with high-dose intravenous beta-lactams (eg, penicillin, ampicillin, amoxicillin, cefuroxime, cefotaxime). Vancomycin is also an acceptable choice for serious infections; however, one strain carries the vanA gene, which is resistant to vancomycin.59 Antibiotic selection should be based on antibiotic sensitivity testing because no clinical trials of treatment of systemic infections have been conducted.

Antibiotics

Although antibiotic therapy decreases the duration of symptoms, whether it prevents sequelae of pharyngeal infection is not known.1,33


Erythromycin (E.E.S, E-Mycin, Eryc, Eryc-Tab, Erythrocin)

Inhibits bacterial growth, possibly by blocking dissociation of peptidyl tRNA from ribosomes, arresting RNA-dependent protein synthesis. For treatment of staphylococcal and streptococcal infections.
In children, age, weight, and severity of infection determine proper dosage. When bid dosing is desired, half of total daily dose may be taken q12h. For more severe infections, double dose. While no controlled studies have been performed, erythromycin has been effective in case series and most strains are susceptible.

Adult

250 mg PO q6h for 10 d

Pediatric

30-50 mg/kg/d PO divided q6h for 10 d; not to exceed 2 g/d

Coadministration may increase toxicity of theophylline, digoxin, carbamazepine, and cyclosporine; may potentiate anticoagulant effects of warfarin; coadministration with lovastatin and simvastatin increases risk of rhabdomyolysis

Documented hypersensitivity; hepatic impairment

Pregnancy

B - Fetal risk not confirmed in studies in humans but has been shown in some studies in animals

Precautions

Caution in liver disease; estolate formulation may cause cholestatic jaundice; adverse GI effects are common (administer doses pc); discontinue if nausea, vomiting, malaise, abdominal colic, or fever develop


Azithromycin (Zithromax)

Acts by binding to 50S ribosomal subunit of susceptible microorganisms and blocks dissociation of peptidyl tRNA from ribosomes, causing RNA-dependent protein synthesis to arrest. Nucleic acid synthesis is not affected. Concentrates in phagocytes and fibroblasts as demonstrated by in vitro incubation techniques. In vivo studies suggest that concentration in phagocytes may contribute to drug distribution to inflamed tissues. Treats mild-to-moderate microbial infections. Shorter course and qd dosing make this a good alternative for patients who are sensitive to penicillin.

Adult

500 mg PO qd for 4-5 d

Pediatric

12 mg/kg/d PO qd for 5 d; not to exceed 500 mg

May increase toxicity of theophylline, warfarin, and digoxin; effects are reduced with coadministration of aluminum and/or magnesium antacids; nephrotoxicity and neurotoxicity may occur when coadministered with cyclosporine

Documented hypersensitivity; hepatic impairment; do not administer with pimozide

Pregnancy

B - Fetal risk not confirmed in studies in humans but has been shown in some studies in animals

Precautions

Site reactions can occur with intravenous route; bacterial or fungal overgrowth may result from prolonged antibiotic use; may increase hepatic enzyme levels and cause cholestatic jaundice; caution in patients with impaired hepatic function, prolonged QT intervals, or pneumonia; caution in hospitalized, geriatric, or debilitated patients


Clindamycin (Cleocin)

Semisynthetic antibiotic produced by 7(S)-chloro-substitution of 7(R)-hydroxyl group of parent compound lincomycin. Inhibits bacterial growth, possibly by blocking dissociation of peptidyl tRNA from ribosomes, causing RNA-dependent protein synthesis to arrest. Widely distributes in the body without penetration of CNS. Protein bound and excreted by the liver and kidneys.
Oral or parenteral antibiotic for anaerobic or susceptible streptococcal, pneumococcal, or staphylococcal species. Considered to have good absorption into bloodstream in both oral and parental forms.

Adult

150-450 mg PO q8h
1.2-2.7 g IV/IM q8h

Pediatric

Neonates: Not established
Infants and children: 15-25 mg/kg/d PO q8h; 25-40 mg/kg/d IV/IM q8h

Increases duration of neuromuscular blockade induced by tubocurarine and pancuronium; erythromycin may antagonize effects; antidiarrheals may delay absorption

Documented hypersensitivity; regional enteritis, ulcerative colitis, hepatic impairment, antibiotic-associated colitis

Pregnancy

B - Fetal risk not confirmed in studies in humans but has been shown in some studies in animals

Precautions

Adjust dose in severe hepatic dysfunction; no adjustment necessary in renal insufficiency; associated with severe and possibly fatal colitis by allowing overgrowth of Clostridium difficile

More on Arcanobacterium Haemolyticum

Overview: Arcanobacterium Haemolyticum
Differential Diagnoses & Workup: Arcanobacterium Haemolyticum
Treatment & Medication: Arcanobacterium Haemolyticum
Follow-up: Arcanobacterium Haemolyticum
Multimedia: Arcanobacterium Haemolyticum
References
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References

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Further Reading

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Keywords

, pharyngitis, cutaneous infections, infections, secretive bacteria, pharyngeal infection

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Contributor Information and Disclosures

Author

Kyle L Horner, MD, MS, Staff Physician, Department of Dermatology, Penn State Milton S Hershey Medical Center
Kyle L Horner, MD, MS is a member of the following medical societies: American Academy of Dermatology, American Medical Association, and Pennsylvania Academy of Dermatology
Disclosure: Nothing to disclose.

Coauthor(s)

Gregory J Raugi, MD, PhD, Professor, Department of Internal Medicine, Division of Dermatology, University of Washington at Seattle; Chief, Dermatology Section, Primary and Specialty Care Service, Veterans Administration Medical Center of Seattle
Gregory J Raugi, MD, PhD is a member of the following medical societies: American Academy of Dermatology
Disclosure: Nothing to disclose.

Kord Honda, MD, Fellow in Dermatopathology, Division of Dermatology, Department of Medicine, University of Cincinnati
Kord Honda, MD is a member of the following medical societies: Phi Beta Kappa
Disclosure: Nothing to disclose.

Medical Editor

Robin Travers, MD, Assistant Professor of Medicine (Dermatology), Dartmouth University School of Medicine; Staff Dermatologist, New England Baptist Hospital; Private Practice, SkinCare Physicians
Robin Travers, MD is a member of the following medical societies: American Academy of Dermatology, American Medical Informatics Association, Massachusetts Medical Society, Medical Dermatology Society, and Women's Dermatologic Society
Disclosure: Nothing to disclose.

Pharmacy Editor

David F Butler, MD, Professor of Dermatology, Texas A&M University College of Medicine; Chair, Department of Dermatology, Director, Dermatology Residency Training Program, Scott and White Clinic, Northside Clinic
David F Butler, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Medical Association, American Society for Dermatologic Surgery, American Society for MOHS Surgery, Association of Military Dermatologists, and Phi Beta Kappa
Disclosure: Nothing to disclose.

Managing Editor

Paul Krusinski, MD, Director of Dermatology, Professor, Department of Internal Medicine, Fletcher Allen Health Care, University of Vermont
Paul Krusinski, MD is a member of the following medical societies: American Academy of Dermatology, American College of Physicians, and Society for Investigative Dermatology
Disclosure: Nothing to disclose.

CME Editor

Glen H Crawford, MD, Assistant Clinical Professor, Department of Dermatology, University of Pennsylvania School of Medicine; Chief, Division of Dermatology, The Pennsylvania Hospital
Glen H Crawford, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Medical Association, Phi Beta Kappa, and Society of USAF Flight Surgeons
Disclosure: Nothing to disclose.

Chief Editor

Dirk M Elston, MD, Director, Department of Dermatology, Geisinger Medical Center
Dirk M Elston, MD is a member of the following medical societies: American Academy of Dermatology
Disclosure: Nothing to disclose.

 
 
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