infectious diseases
Actinomycosis
Treatment of Actinomycosis
High-dose penicillin Most patients with actinomycosis respond to antibiotics, but response is usually slow because of extensive tissue induration and the relatively avascular nature of the lesions. Therefore, treatment must be continued for at least 8 weeks and occasionally for≥1 year, until symptoms and signs have resolved. High doses ofpenicillin G(eg, 3 to 5 million units IV every 6 hours) are usually effective.Penicillin V1 g orally 4 times a day may be substituted after about 2 to 6 weeks. Oraltetracycline500 mg every 6 hours ordoxycycline100 mg every 12 hours may be given instead of penicillin.Minocycline,clindamycin, anderythromycinhave also been successful. Antibiotic regimens may be broadened to cover other pathogens cultured from lesions. Treatment of IUD-associated pelvic actinomycosis also involves removal of the IUD. Extensive pelvic disease may require drainage of intra-abdominal abscesses, sometimes with hysterectomy and salpingo-oophorectomy. Anecdotal reports suggest that hyperbaric oxygen therapy is helpful. Extensive and repeated surgical procedures may be required. Sometimes small abscesses can be aspirated; large ones are drained, and fistulas are excised surgically. 