eMedicine Specialties > Pediatrics: General Medicine > Infectious Disease
Actinomycosis: Treatment & Medication
Updated: Jun 27, 2008
- Overview
- Differential Diagnoses & Workup
- Treatment & Medication
- Follow-up
Treatment
Medical Care
- In patients whose actinomycosis is not critical, the option to treat medically along with prolonged courses of antibiotics is an acceptable alternative.
- A combined medical-surgery approach is frequently needed for complicated disease, especially when thoracic, abdominal, or CNS disease is present.
- The duration of therapy is prolonged and should be extended well beyond resolution of symptoms to decrease the likelihood of recurrence.
Surgical Care
- Surgery is indicated for resection of necrotic tissue, debulking of large masses, sinus tract excision, incision and drainage of empyemas, and abscesses and bone curettage.
- Surgery alone is not curative, and the use of prolonged courses of antibiotics is always required.
Consultations
- Pediatric surgeon
- Pediatric infectious diseases specialist
- Ear, nose, and throat specialist
- Dentist and/or maxillofacial surgeon
- Gynecologist
Medication
Antibiotics
For most complicated cases, 4-6 wk of intravenous penicillin G followed by 6-12 months of oral penicillin V is indicated. For patients with penicillin allergy, clindamycin, ceftriaxone, chloramphenicol, and tetracyclines are good alternatives. Parenteral and oral combinations of these drugs have been successful. Because co-infection with A actinomycetemcomitans is common, covering for this organism when present is important, especially in patients who are critically ill. Actinomycosis is susceptible to third-generation cephalosporins, rifampin, trimethoprim-sulfamethoxazole, ciprofloxacin, tetracyclines, and chloramphenicol.
Penicillin G (Pfizerpen)
First-line drug. Used for IV courses of 4-6 wk. Interferes with synthesis of cell wall mucopeptide during active multiplication, resulting in bactericidal activity against susceptible microorganisms.
Adult
Cervicofacial actinomycosis: 1-6 million U/d IV divided q6h
Other types of actinomycosis: 10-20 million U/d IV divided q6h
Pediatric
250,000-400,000 U/kg/d IV divided q6h
Probenecid can increase effects of penicillin; coadministration of tetracyclines can decrease effects of penicillin
Documented hypersensitivity
Pregnancy
B - Fetal risk not confirmed in studies in humans but has been shown in some studies in animals
Precautions
Serum sickness; neutropenia with large and prolonged doses; interstitial nephritis; hypokalemia with large doses; GI disturbances
Penicillin V potassium (Beepen-VK, Betapen-VK, Pen-Vee K)
First-line drug to be used as follow-up on previous parenteral therapy.
Adult
250-500 mg PO q6h
Pediatric
25-50 mg/kg/d PO divided tid/qid
Probenecid can increase effects of penicillin; coadministration of tetracyclines can decrease effects of penicillin
Documented hypersensitivity
Pregnancy
B - Fetal risk not confirmed in studies in humans but has been shown in some studies in animals
Precautions
Use caution with impaired renal function; do not use with nausea, vomiting, gastroparesis, or intestinal hypermotility
Clindamycin (Cleocin)
Second-line drug. Inhibits bacterial growth, possibly by blocking dissociation of peptidyl tRNA from ribosomes, causing RNA-dependent protein synthesis to arrest.
Adult
150-450 mg/dose PO q6-8h; not to exceed 1.8 g/d
600-1200 mg/d IV/IM divided q6-8h
Pediatric
25-30 mg/kg/d PO divided q6-8h; not to exceed 1.8 g/d
25-40 mg/kg/d IV divided q6-8h
Increases duration of neuromuscular blockade, induced by tubocurarine and pancuronium; erythromycin may antagonize effects of clindamycin; antidiarrheals may delay absorption of clindamycin
Documented hypersensitivity; regional enteritis, ulcerative colitis, hepatic impairment, antibiotic-associated colitis
Pregnancy
C - Fetal risk revealed in studies in animals but not established or not studied in humans; may use if benefits outweigh risk to fetus
Precautions
Adjust dose in severe hepatic dysfunction; no adjustment necessary in renal insufficiency; associated with severe and possibly fatal colitis
Chloramphenicol (Chloromycetin)
Second-line drug. The PO form is unavailable in the United States. Only use when no other alternatives are available. Binds to 50S bacterial-ribosomal subunits and inhibits bacterial growth by inhibiting protein synthesis.
Adult
250-750 mg PO q6h
1 g IV q6h
Pediatric
50-100 mg/kg/d PO/IV divided q6h
Concurrent administration with barbiturates, chloramphenicol serum levels may decrease while barbiturate levels may increase causing toxicity; manifestations of hypoglycemia may develop with sulfonylureas; rifampin may reduce serum chloramphenicol levels, presumably through hepatic enzyme induction; may increase effects of anticoagulants; may increase serum hydantoin levels, possibly resulting in toxicity; chloramphenicol levels may be increased or decreased
Documented hypersensitivity; do not use for trivial infections or when not indicated; do not use as a prophylactic agent
Pregnancy
C - Fetal risk revealed in studies in animals but not established or not studied in humans; may use if benefits outweigh risk to fetus
Precautions
Obtain baseline blood studies followed by periodic blood studies during treatment; suspend therapy on appearance of leukopenia, reticulocytopenia, anemia, or thrombocytopenia; avoid repeated courses; avoid concurrent use with other bone marrow suppressive agents; extreme precaution when using in term or premature newborns
Ceftriaxone (Rocephin)
Second-line drug. Arrests bacterial growth by binding to one or more penicillin binding proteins.
Adult
1-2 g IV qd or divided bid; not to exceed 4 g/d
Pediatric
50-75 mg/kg/d IV qd or divided bid
Probenecid may increase ceftriaxone levels; coadministration with ethacrynic acid, furosemide, and aminoglycosides may increase nephrotoxicity
Documented hypersensitivity
Pregnancy
B - Fetal risk not confirmed in studies in humans but has been shown in some studies in animals
Precautions
Adjust dose in renal impairment; caution in breastfeeding women or patients allergic to penicillin; reports of ultrasonographic gallbladder changes
Tetracycline HCl (Sumycin)
Second-line drug. Inhibits bacterial protein synthesis by binding with 30S and possibly 50S ribosomal subunit(s).
Adult
250-500 mg PO q6h
Pediatric
<8 years: Contraindicated
>8 years: 25-50 mg/kg/d PO divided q6-12h
Bioavailability decreases with antacids that contain aluminum, calcium, magnesium, iron, or bismuth subsalicylate; can decrease effects of PO contraceptives, causing breakthrough bleeding and increased risk of pregnancy; tetracyclines can increase hypoprothrombinemic effects of anticoagulants
Documented hypersensitivity; do not use in children <8 y; severe hepatic dysfunction
Pregnancy
D - Fetal risk shown in humans; use only if benefits outweigh risk to fetus
Precautions
Photosensitivity may develop with prolonged exposure to sunlight or tanning equipment; reduce dose in renal impairment; consider drug serum level determinations in prolonged therapy; tetracycline use during tooth development (second half of pregnancy through age 8 y) can cause permanent discoloration of teeth; Fanconilike syndrome may develop with outdated tetracyclines
More on Actinomycosis |
| Overview: Actinomycosis |
| Differential Diagnoses & Workup: Actinomycosis |
 Treatment & Medication: Actinomycosis |
| Follow-up: Actinomycosis |
| References |
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References
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Further Reading
Keywords
actinomycosis, actinophytosis, lumpy jaw, Actinomyces, Actinomyces israelii, A israelii, Actinomyces naeslundii, A naeslundii, Actinomyces odontolyticus, A odontolyticus, Actinomyces viscosus, A viscosus, Actinomyces meyeri, A meyeri, infections of the oral region, infections of the cervicofacial region, cervicofacial actinomycosis, thoracic actinomycosis, abdominal actinomycosis, pelvic actinomycosis, Actinobacillus actinomycetemcomitans, Eikenella corrodens, Fusobacterium, Bacteroides, Capnocytophaga, Staphylococcus, Streptococcus, Enterococcus pulmonary infection, appendicitis, diverticulitis, tonsillitis, mastoiditis, otitis, periostitis, osteomyelitis, pneumonia, tuberculosis, tracheoesophageal fistulas, pericarditis, myocarditis, endocarditis, typhoid fever, amebic dysentery, intrauterine contraceptive device, pneumonitis, pleural effusion
