Actinomycosis Treatment & Management

Updated: Jul 24, 2018
  • Author: Jason F Okulicz, MD, FACP, FIDSA; Chief Editor: Michael Stuart Bronze, MD  more...
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Treatment

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.

Parenteral antibiotics are administered initially via PICC line, with transition to oral agents.

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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]

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Consultations

See the list below:

  • Interventional radiologist

  • Surgeon

  • Infectious diseases specialist

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Diet

No specific dietary precautions are indicated in patients with actinomycosis.

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Activity

Patients with actinomycosis may be active to the degree tolerated.

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Prevention

Maintenance of good oral hygiene and adequate regular dental care are important.

Patients and physicians alike should be aware of the increased risk of infection associated with insertion of IUCD.

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Long-Term Monitoring

Follow up on outpatient intravenous antibiotic programs and switch patients to oral antibiotic therapy. Prolonged antibiotic therapy is often required.

Use CT scanning and MRI to monitor the response to therapy.

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Further Inpatient Care

Obtain imaging studies and percutaneous diagnostic studies to allow more expedient diagnosis of actinomycosis.

Place a peripherally inserted central catheter (PICC) for administration of intravenous antibiotics.

Arrange outpatient intravenous antibiotic therapy.

If penicillin therapy is failing, consider broadening the antimicrobial spectrum to cover the potentially uncultured companion bacteria.

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Transfer

If a CT scanner or interventional radiology is not available, transfer to a facility with these services.

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