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Actinomycosis Treatment & Management

  • Author: Jason F Okulicz, MD, FACP, FIDSA; Chief Editor: Michael Stuart Bronze, MD  more...
Updated: Mar 18, 2016

Medical Care

In most cases of actinomycosis, antimicrobial therapy is the only treatment required, although surgery can be adjunctive in selected cases. Penicillin G is the drug of choice for treating infections caused by actinomycetes.


Surgical Care

Attempt to cure actinomycosis, including extensive disease, with aggressive antimicrobial therapy alone initially. Surgical therapy may include incision and drainage of abscesses, excision of sinus tracts and recalcitrant fibrotic lesions, decompression of closed-space infections, and interventions aimed at relieving obstruction (eg, when actinomycotic lesions compress the ureter). In a case series of 23 patients with abdominal actinomycosis, approximately 50% of patients required emergency surgery for symptoms of peritonitis.[7]



See the list below:

  • Interventional radiologist
  • Surgeon
  • Infectious diseases specialist


No specific dietary precautions are indicated in patients with actinomycosis.



Patients with actinomycosis may be active to the degree tolerated.

Contributor Information and Disclosures

Jason F Okulicz, MD, FACP, FIDSA Director, HIV Medical Evaluation Unit, Infectious Disease Service, San Antonio Military Medical Center; Associate Professor of Medicine, F Edward Hebert School of Medicine, Uniformed Services University of the Health Sciences; Clinical Associate Professor of Medicine, University of Texas Health Science Center at San Antonio; Adjunct Clinical Instructor, Feik School of Pharmacy, University of the Incarnate Word

Jason F Okulicz, MD, FACP, FIDSA is a member of the following medical societies: Alpha Omega Alpha, American College of Physicians-American Society of Internal Medicine, Infectious Diseases Society of America

Disclosure: Nothing to disclose.


Hari Polenakovik, MD, FACP, FIDSA Associate Professor of Medicine, Wright State University, Boonshoft School of Medicine

Hari Polenakovik, MD, FACP, FIDSA is a member of the following medical societies: Alpha Omega Alpha, American College of Physicians, American Society for Microbiology, Society for Healthcare Epidemiology of America, European Society of Clinical Microbiology and Infectious Diseases, Infectious Diseases Society of America

Disclosure: Nothing to disclose.

Sylvia Polenakovik, MD Internist, Department of Internal Medicine, Sycamore Hospital; Internist, Miami Valley Hospitalist Group, MVH; Clinical Instructor, Wright State University, Boonshoft School of Medicine

Sylvia Polenakovik, MD is a member of the following medical societies: American College of Physicians-American Society of Internal Medicine, Society of Hospital Medicine

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Joseph F John, Jr, MD, FACP, FIDSA, FSHEA Clinical Professor of Medicine, Molecular Genetics and Microbiology, Medical University of South Carolina College of Medicine; Associate Chief of Staff for Education, Ralph H Johnson Veterans Affairs Medical Center

Joseph F John, Jr, MD, FACP, FIDSA, FSHEA is a member of the following medical societies: Charleston County Medical Association, Infectious Diseases Society of America, South Carolina Infectious Diseases Society

Disclosure: Nothing to disclose.

Chief Editor

Michael Stuart Bronze, MD David Ross Boyd Professor and Chairman, Department of Medicine, Stewart G Wolf Endowed Chair in Internal Medicine, Department of Medicine, University of Oklahoma Health Science Center; Master of the American College of Physicians; Fellow, Infectious Diseases Society of America

Michael Stuart Bronze, MD is a member of the following medical societies: Alpha Omega Alpha, American Medical Association, Oklahoma State Medical Association, Southern Society for Clinical Investigation, Association of Professors of Medicine, American College of Physicians, Infectious Diseases Society of America

Disclosure: Nothing to disclose.

Additional Contributors

Daniel R Lucey, MD, MPH, MD, MPH 

Daniel R Lucey, MD, MPH, MD, MPH is a member of the following medical societies: Alpha Omega Alpha, American College of Physicians

Disclosure: Nothing to disclose.

  1. Hall V. Actinomyces--gathering evidence of human colonization and infection. Anaerobe. 2008 Feb. 14(1):1-7. [Medline].

  2. Ruggiero SL, Mehrotra B, Rosenberg TJ, Engroff SL. Osteonecrosis of the jaws associated with the use of bisphosphonates: a review of 63 cases. J Oral Maxillofac Surg. 2004 May. 62(5):527-34. [Medline].

  3. Markiewicz MR, Margarone JE 3rd, Campbell JH, Aguirre A. Bisphosphonate-associated osteonecrosis of the jaws: a review of current knowledge. J Am Dent Assoc. 2005 Dec. 136(12):1669-74. [Medline].

  4. Hansen T, Kunkel M, Weber A, James Kirkpatrick C. Osteonecrosis of the jaws in patients treated with bisphosphonates - histomorphologic analysis in comparison with infected osteoradionecrosis. J Oral Pathol Med. 2006 Mar. 35(3):155-60. [Medline].

  5. Könönen E, Wade WG. Actinomyces and related organisms in human infections. Clin Microbiol Rev. 2015 Apr. 28 (2):419-42. [Medline].

  6. Westhoff C. IUDs and colonization or infection with Actinomyces. Contraception. 2007 Jun. 75(6 Suppl):S48-50. [Medline].

  7. Sung HY, Lee IS, Kim SI, Jung SE, Kim SW, Kim SY. Clinical Features of Abdominal Actinomycosis: A 15-year Experience of A Single Institute. J Korean Med Sci. 2011 Jul. 26(7):932-7. [Medline].

  8. Sudhakar SS, Ross JJ. Short-term treatment of actinomycosis: two cases and a review. Clin Infect Dis. 2004 Feb 1. 38(3):444-7. [Medline].

  9. Macfarlane DJ, Tucker LG, Kemp RJ. Treatment of recalcitrant actinomycosis with ciprofloxacin. J Infect. 1993 Sep. 27(2):177-80. [Medline].

  10. Ferreira Dde F, Amado J, Neves S, Taveira N, Carvalho A, Nogueira R. Treatment of pulmonary actinomycosis with levofloxacin. J Bras Pneumol. 2008 Apr. 34(4):245-8. [Medline].

  11. Apotheloz C, Regamey C. Disseminated infection due to Actinomyces meyeri: case report and review. Clin Infect Dis. 1996 Apr. 22(4):621-5. [Medline].

  12. Arend SM, Oosterhof H, van Dissel JT. Actinomyces and the intrauterine device. Arch Intern Med. 1998 Jun 8. 158(11):1270. [Medline].

  13. Belmont MJ, Behar PM, Wax MK. Atypical presentations of actinomycosis. Head Neck. 1999 May. 21(3):264-8. [Medline].

  14. Brown JR. Human actinomycosis. A study of 181 subjects. Hum Pathol. 1973 Sep. 4(3):319-30. [Medline].

  15. Cayley J, Fotherby K, Guillebaud J, et al. Recommendations for clinical practice: actinomyces like organisms and intrauterine contraceptives. The Clinical and Scientific Committee. Br J Fam Plann. 1998 Jan. 23(4):137-8. [Medline].

  16. Chaudhry SI, Greenspan JS. Actinomycosis in HIV infection: a review of a rare complication. Int J STD AIDS. 2000 Jun. 11(6):349-55. [Medline].

  17. Choi J, Koh WJ, Kim TS, et al. Optimal duration of IV and oral antibiotics in the treatment of thoracic actinomycosis. Chest. 2005 Oct. 128(4):2211-7. [Medline].

  18. Chouabe S, Perdu D, Deslee G, et al. Endobronchial actinomycosis associated with foreign body: four cases and a review of the literature. Chest. 2002 Jun. 121(6):2069-72. [Medline].

  19. Cintron JR, Del Pino A, Duarte B, Wood D. Abdominal actinomycosis. Dis Colon Rectum. 1996 Jan. 39(1):105-8. [Medline].

  20. Clarridge JE, Zhang Q. Genotypic diversity of clinical Actinomyces species: phenotype, source, and disease correlation among genospecies. J Clin Microbiol. 2002 Sep. 40(9):3442-8. [Medline].

  21. Colmegna I, Rodriguez-Barradas M, Rauch R, Clarridge J, Young EJ. Disseminated Actinomyces meyeri infection resembling lung cancer with brain metastases. Am J Med Sci. 2003 Sep. 326(3):152-5. [Medline].

  22. Curi MM, Dib LL, Kowalski LP, et al. Opportunistic actinomycosis in osteoradionecrosis of the jaws in patients affected by head and neck cancer: incidence and clinical significance. Oral Oncol. 2000 May. 36(3):294-9. [Medline].

  23. de Montpreville VT, Nashashibi N, Dulmet EM. Actinomycosis and other bronchopulmonary infections with bacterial granules. Ann Diagn Pathol. 1999 Apr. 3(2):67-74. [Medline].

  24. Endo S, Murayama F, Yamaguchi T, et al. Surgical considerations for pulmonary actinomycosis. Ann Thorac Surg. 2002 Jul. 74(1):185-90. [Medline].

  25. Felekouras E, Menenakos C, Griniatsos J, et al. Liver resection in cases of isolated hepatic actinomycosis: case report and review of the literature. Scand J Infect Dis. 2004. 36(6-7):535-8. [Medline].

  26. Fife TD, Finegold SM, Grennan T. Pericardial actinomycosis: case report and review. Rev Infect Dis. 1991 Jan-Feb. 13(1):120-6. [Medline].

  27. Göçmen G, Varol A, Göker K, Basa S. Actinomycosis: report of a case with a persistent extraoral sinus tract. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2011 Dec. 112(6):e121-3. [Medline].

  28. Hamid D, Baldauf JJ, Cuenin C, Ritter J. Treatment strategy for pelvic actinomycosis: case report and review of the literature. Eur J Obstet Gynecol Reprod Biol. 2000 Apr. 89(2):197-200. [Medline].

  29. Hansen T, Kunkel M, Kirkpatrick CJ, Weber A. Actinomyces in infected osteoradionecrosis--underestimated?. Hum Pathol. 2006 Jan. 37(1):61-7. [Medline].

  30. Hsieh MJ, Liu HP, Chang JP, Chang CH. Thoracic actinomycosis. Chest. 1993 Aug. 104(2):366-70. [Medline].

  31. Huang KL, Beutler SM, Wang C. Endocarditis due to Actinomyces meyeri. Clin Infect Dis. 1998 Oct. 27(4):909-10. [Medline].

  32. Kim JC, Ahn BY, Kim HC, et al. Efficiency of combined colonoscopy and computed tomography for diagnosis of colonic actinomycosis: a retrospective evaluation of eight consecutive patients. Int J Colorectal Dis. 2000 Aug. 15(4):236-42. [Medline].

  33. Kim TS, Han J, Koh WJ, et al. Thoracic Actinomycosis: CT Features with Histopathologic Correlation. AJR Am J Roentgenol. 2006 Jan. 186(1):225-31. [Medline].

  34. Kuijper EJ, Wiggerts HO, Jonker GJ, et al. Disseminated actinomycosis due to Actinomyces meyeri and Actinobacillus actinomycetemcomitans. Scand J Infect Dis. 1992. 24(5):667-72. [Medline].

  35. Lequerre T, Nouvellon M, Kraznowska K, et al. Septic arthritis due to Actinomyces naeslundii: report of a case. Joint Bone Spine. 2002 Oct. 69(5):499-501. [Medline].

  36. Lippes J. Pelvic actinomycosis: a review and preliminary look at prevalence. Am J Obstet Gynecol. 1999 Feb. 180(2 Pt 1):265-9. [Medline].

  37. Litwin KA, Jadbabaie F, Villanueva M. Case of pleuropericardial disease caused by Actinomyces odontolyticus that resulted in cardiac tamponade. Clin Infect Dis. 1999 Jul. 29(1):219-20. [Medline].

  38. Mabeza GF, Macfarlane J. Pulmonary actinomycosis. Eur Respir J. 2003 Mar. 21(3):545-51. [Medline].

  39. Macfarlane DJ, Tucker LG, Kemp RJ. Treatment of recalcitrant actinomycosis with ciprofloxacin. J Infect. 1993 Sep. 27(2):177-80. [Medline].

  40. Oostman O, Smego RA. Cervicofacial Actinomycosis: Diagnosis and Management. Curr Infect Dis Rep. 2005 May. 7(3):170-174. [Medline].

  41. Pulverer G, Schutt-Gerowitt H, Schaal KP. Human cervicofacial actinomycoses: microbiological data for 1997 cases. Clin Infect Dis. 2003 Aug 15. 37(4):490-7. [Medline].

  42. Reddy I, Ferguson DA Jr, Sarubbi FA. Endocarditis due to Actinomyces pyogenes. Clin Infect Dis. 1997 Dec. 25(6):1476-7. [Medline].

  43. Rothschild B, Naples V, Barbian L. Bone manifestations of actinomycosis. Ann Diagn Pathol. 2006 Feb. 10(1):24-27. [Medline].

  44. Sabbe LJ, Van De Merwe D, Schouls L, et al. Clinical spectrum of infections due to the newly described Actinomyces species A. turicensis, A. radingae, and A. europaeus. J Clin Microbiol. 1999 Jan. 37(1):8-13. [Medline].

  45. Scarano FJ, Ruddat MS, Robinson A. Actinomyces viscosus postoperative endophthalmitis. Diagn Microbiol Infect Dis. 1999 Jun. 34(2):115-7. [Medline].

  46. Schaal KP, Lee HJ. Actinomycete infections in humans--a review. Gene. 1992 Jun 15. 115(1-2):201-11. [Medline].

  47. Schaal KP, Pape W. Special methodological problems in antibiotic susceptibility testing of fermentative actinomycetes. Infection. 1980. 8 Suppl 2:S176-82. [Medline].

  48. Sharma M, Briski LE, Khatib R. Hepatic actinomycosis: an overview of salient features and outcome of therapy. Scand J Infect Dis. 2002. 34(5):386-91. [Medline].

  49. Smego RA Jr, Foglia G. Actinomycosis. Clin Infect Dis. 1998 Jun. 26(6):1255-61; quiz 1262-3. [Medline].

  50. Smith AJ, Hall V, Thakker B, Gemmell CG. Antimicrobial susceptibility testing of Actinomyces species with 12 antimicrobial agents. J Antimicrob Chemother. 2005 Aug. 56(2):407-9. [Medline].

  51. Soria-Aledo V, Flores-Pastor B, Carrasco-Prats M, et al. Abdominopelvic actinomycosis: a serious complication in intrauterine device users. Acta Obstet Gynecol Scand. 2004 Sep. 83(9):863-5. [Medline].

  52. Wagenlehner FM, Mohren B, Naber KG, Mannl HF. Abdominal actinomycosis. Clin Microbiol Infect. 2003 Aug. 9(8):881-5. [Medline].

  53. Warren NG. Actinomycosis, nocardiosis, and actinomycetoma. Dermatol Clin. 1996 Jan. 14(1):85-95. [Medline].

  54. Weese WC, Smith IM. A study of 57 cases of actinomycosis over a 36-year period. A diagnostic 'failure' with good prognosis after treatment. Arch Intern Med. 1975 Dec. 135(12):1562-8. [Medline].

  55. Wust J, Steiger U, Vuong H, Zbinden R. Infection of a hip prosthesis by Actinomyces naeslundii. J Clin Microbiol. 2000 Feb. 38(2):929-30. [Medline].

  56. Xia T, Baumgartner JC. Occurrence of Actinomyces in infections of endodontic origin. J Endod. 2003 Sep. 29(9):549-52. [Medline].

  57. Yung BC, Cheng JC, Chan TT, et al. Aggressive thoracic actinomycosis complicated by vertebral osteomyelitis and epidural abscess leading to spinal cord compression. Spine. 2000 Mar 15. 25(6):745-8. [Medline].

Actinomycosis in the endometrial tissue, low-power view. Image courtesy of Paul Gibbs, MD.
Actinomycosis in the endometrial tissue, high-power view. Image courtesy of Paul Gibbs, MD.
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