actinomycosis

Q: 58 years old male with history of Crohn's disease is referred from outside hospital for higher level of care for abdominal actinomycosis. Which of the following antibiotics is the drug of choice? (select one)

  

A) Aminoglycosides

B) Metronidazole

C) Trimethoprim-sulfamethoxazole

D) Antifungal 

E) High-dose penicillin

  

  

Answer: E

  

High-dose penicillin (choice E) is the drug of choice in severe, invasive or extensive actinomycosis. It requires prolonged intravenous (IV) infusion. Once clinical situation improves or in mild cases, oral form can be used. These patients frequently require surgical interventions. In patients with penicillin allergy ceftriaxone, doxycycline, macrolides or carbapenems can be used.

 

It is important to know that aminoglycosides, metronidazole, aztreonam, trimethoprim-sulfamethoxazole, nafcillin, oxacillin, cephalexin, ceftazidime, and/or antifungal drugs have no tole in the treatment of actinomycosis. Clindamycin and fluoroquinolones have been described but lacks data in this regard.

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References:

1. Valour F, Sénéchal A, Dupieux C, Karsenty J, Lustig S, Breton P, Gleizal A, Boussel L, Laurent F, Braun E, Chidiac C, Ader F, Ferry T. Actinomycosis: etiology, clinical features, diagnosis, treatment, and management. Infect Drug Resist. 2014 Jul 5;7:183-97. doi: 10.2147/IDR.S39601. PMID: 25045274; PMCID: PMC4094581.

2. Boyanova L, Kolarov R, Mateva L, Markovska R, Mitov I. Actinomycosis: a frequently forgotten disease. Future Microbiol. 2015;10(4):613-28. doi: 10.2217/fmb.14.130. PMID: 25865197.

3. LeCorn DW, Vertucci FJ, Rojas MF, et al. In vitro activity of amoxicillin, clindamycin, doxycycline, metronidazole, and moxifloxacin against oral Actinomyces. J Endod 2007; 33:557.