Dermatologic Aspects of Actinomycosis Treatment & Management

Updated: Dec 11, 2020
  • Author: Juanita Duran, MD; Chief Editor: Dirk M Elston, MD  more...
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Treatment

Medical Care

The treatment of actinomycosis may require extended antibiotic therapy and surgical interventions as pertinent. Medications should be adjusted based on individual patient needs. Actinomyces species are in general susceptible to penicillin and other beta-lactam antibiotics, as well as to most agents used to treat infections by gram-positive anaerobic rods. Susceptibility to clindamycin is variable, with resistance varying from 17-33%. [34] Metronidazole and aminoglycosides are ineffective against these species. [3]

If the actinomycosis is recognized early, cervicofacial infection has a good prognosis with the use of antibiotics alone. In the treatment of actinomycosis, tetracyclines are as effective as penicillin. Intravenous or intramuscular benzylpenicillin at a dose of 20 million IU/day is not uncommon. Oral amoxicillin is recommended at a dose of 2-4 g/day. Patients should be treated for a minimum of 3 months, preferably extending the treatment 2-3 weeks after symptoms have subsided. [3] Medication adjustments based on individual minimum inhibitory concentrations (MICs) may be required. Differences in MICs among Actinomyces species are known, with Actinomyces  europaeus and Actinomyces turicensis being the most resistant. [5]

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Surgical Care

Surgical management in actinomycosis has consisted of various treatment modalities, including excision of sinus tracts, drainage of the abscess cavities, removal of bulky infected masses, and irrigation and curettage of the osteomyelitic bony lesions. [35]

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